2023-12-31-accounts

Annual Report and Accounts Year to 31 December 2023

Charity registration number: 213128

QNI Annual Report and Accounts Year to 31 December 2023 1

In May 2024, Her Majesty Queen Camilla became the sixth royal Patron of the charity.

‘I am delighted that Her Majesty Queen Camilla has agreed to become Patron of the Queen’s Nursing Institute (QNI), the charity that bears her title. Queen’s Nurses in England, Wales and Northern Ireland will I’m sure be honoured and encouraged by this news. We look forward to a warm and rewarding relationship with our new Patron who has shown herself as a passionate advocate for healthcare for people of all ages.’

Dr Crystal Oldman CBE, QNI Chief Executive.

Photo courtesy of Hugh Barnand

2 QNI Annual Report and Accounts Year to 31 December 2023

Contents

Reports

Reference and administrative information about the charity, its

members of Council and advisers Foreword from the Chair Report of the Council Independent auditor’s report Accounts Statement of fnancial activities Balance sheet Statement of cash fows Principal accounting policies Notes to the accounts	members of Council and advisers Foreword from the Chair Report of the Council Independent auditor’s report Accounts Statement of fnancial activities Balance sheet Statement of cash fows Principal accounting policies Notes to the accounts	members of Council and advisers Foreword from the Chair Report of the Council Independent auditor’s report Accounts Statement of fnancial activities Balance sheet Statement of cash fows Principal accounting policies Notes to the accounts	members of Council and advisers Foreword from the Chair Report of the Council Independent auditor’s report Accounts Statement of fnancial activities Balance sheet Statement of cash fows Principal accounting policies Notes to the accounts	4 6 9 30 33 35 36 37 41

QNI Annual Report and Accounts Year to 31 December 2023 3

Reference and administrative information about the charity, its members of Council and advisers

Patron	Her Majesty Queen Camilla (May 2024)
Vice Presidents	Dr June Crown CBE Professor Sir Sam Everington OBE Zahir Fazal Professor Dame Elizabeth Anionwu DBE OM
The members of Council (Trustees) at the date of this report, and those who served during 2023, are as follows:
Chair of Council	Professor John Unsworth OBE Nick Addyman# + Dale Carrington Richard Fass# + Dr Judith Graham BEM Dr Katerina Kolyva (retired from Council March 2024) Rosalynde Lowe CBE Dr Angela McLernon OBE (retired from Council March 2024) Helen Mehra Dr Jenni Middleton Dr Joan Myers OBE Dr Rebecca Myers#+ Christine O’Connell# + Dr Neesha Oozageer Gunowa Jeremy Taylor OBE * Council members nominated and appointed by the Patron # Members of the Finance Committee + Members of the Remuneration Committee
Honorary Treasurer
Vice Chair
Chief Executive	Dr Crystal Oldman CBE, EdD, MSc, MA, PGDip, PGCEA, RGN, RHV, RNT, QN, FRCN
Charity registration number	213128

4 QNI Annual Report and Accounts Year to 31 December 2023

Reference and administrative information about the charity, its members of Council and advisers

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||| |---|---| |Principal office|1A Henrietta Place| |London| |W1G 0LZ| |Telephone|020 7549 1400| |Email|[e-mail]| |Website|www.qni.org.uk| |Twitter|@TheQNI| |Facebook|The Queen’s Nursing Institute| |LinkedIn|The Queen’s Nursing Institute| |Instagram|@theqni| |Auditor|Buzzacott LLP| |130 Wood Street| |London| |EC2V 6DL| |Investment managers|Rathbone Investment| |Management Limited| |Port of Liverpool Building| |Pier Head| |Liverpool| |L3 1NW| |Bankers|CAF Bank Limited| |25 Kings Hill Avenue| |Kings Hill| |West Malling| |Kent| |ME19 4JQ| |Solicitors|Russell Cooke LLP| |2 Putney Hill| |London| |SW15 6AB|

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QNI Annual Report and Accounts Year to 31 December 2023 5

Foreword from the Chair

2023 represented another hugely successful year for the Queen’s Nursing Institute, during which we consolidated our role as the leading professional organisation for community nursing. The year had several stand-out moments, but for me, the major achievement was the development and publishing of advanced practice standards for nine fields of community nursing practice.

These standards represent the cumulation of our work to develop field specific standards for education, which have moved from voluntary standards to standards which now attract QNI endorsement for educational provision. Huge thanks go to the QNI team who led this work, overseen by our very own Dr Agnes Fanning and to all the individuals who contributed to standards reference groups. During 2024 we will see the first universities achieve endorsement of their programmes against the standards. There has been international interest in the standards as well and the QNI will present the work as part of developing advanced practice roles to achieve universal health coverage at the International Council of Nurses Advanced Nursing Practice conference taking place in Aberdeen in September 2024.

Alongside the nine new sets of standards, we published an updated report on Nursing in the Digital Age (2023) following a survey of more than 1,200 practitioners during 2022. Reports on our innovation projects, the Elsie Wagg Scholarships and our standards for practice teaching were also published during the year. Alongside our numerous events and outstanding annual conference our brilliant communications, publications and events teams ensured that the work of the Institute ‘hit the headlines’ and reached nurses, managers and policy makers alike. Huge thanks to the teams for this excellent work.

February 2023 saw the launch of the Integrated Care Board (ICB) Chief Nurse Network in partnership with the NHS Confederation. Sponsored by Hallam Medical, the ICB Chief Nurse Network provides support to the senior nurse leaders in each of the Integrated Care Boards in England. The network met six times during 2023 under the leadership of Lou Patten, QNI Fellow and ICS Strategic Advisor at the NHS Confederation. We are grateful to Hallam Medical for their support and to Lou for expertly leading the network. Hallam Medical are a significant supporter of our work, which includes sponsorship of the Community Nurse Executive Network (CNEN) and our annual conference, which we were able to offer free to attendees from across the world.

The QNI has a long history from its founding in 1887, and during 2023 we were able to take stock of that history and examine its relevance to our contemporary work. Remarkably, many of the roles the QNI has fulfilled since its inception are still in place today, including developing standards, undertaking research, offering education and training and supporting nurses. Dr Crystal Oldman appeared on the BBC’s Antiques Roadshow in February 2023 to talk about nursing in the community and Professor Dame Elizabeth Anionwu, one of our Vice-Presidents, also appeared on the same programme.

May 2023 saw the first ever William Rathbone X Award and annual lecture. The award and annual lecture were named after my late colleague, William Rathbone, the great-great-grandson of the founder of the Institute. Bill (William) Rathbone the tenth served on the QNI Council for almost 48 years before his death at the end of 2022. It was a huge privilege to work alongside Bill Rathbone, and the award and annual lecture funded by his son-in-law, Nick Addyman, a current QNI Council Member, is a fitting tribute to him. The well-deserved award for Executive Nurse Leadership went to Michelle Bateman, Queen’s Nurse and Executive Director of Nursing, Allied Health Professionals and Quality, Derbyshire Community Health Services NHS Foundation Trust.

“ Remarkably, many of the roles the QNI has fulfilled since its inception are still in place today, including developing standards, undertaking research, offering education and training and supporting nurses.

Professor John Unsworth OBE, Chair of Council

6 QNI Annual Report and Accounts Year to 31 December 2023

Above:

The William Rathbone X Award and Annual Lecture in 2023, with winner Michelle Bateman

The William Rathbone X annual lecture was delivered by Professor Alison Leary MBE, ICNO Director and Chair of Healthcare and Workforce Modelling at London South Bank University. She spoke thoughtfully about workforce challenges, inviting the audience to think differently about these challenges and how to solve them. Alison’s lecture was exceptionally well attended and has subsequently been viewed more than 3,000 times online.

In June 2023, Dr Crystal Oldman and I attended the International Council of Nurses (ICN) annual congress in Montreal, Canada. Following the three-day Council meeting of Nursing Representatives (with more than 130 National Nursing Associations), there were keynote speeches and presentations from colleagues around the world. The QNI was one of the organisations which helped found the ICN in 1899 and was described at the time as one of the few organized bodies of nurses in Britain. The Institute was proud to rejoin the ICN in 2021. We look forward to partnering with the Gambian National Nursing Association during 2024, supporting them to achieve changes to national standards of nurse education and practice in The Gambia.

Our Queen’s Nurse community grew by more than 500 during 2023, taking the total to almost 2,500 working nurses (with a growing number on the retired list). Queen’s Nurses are our greatest asset; they are the modern-day ambassadors for the Institute as the original Queen’s Nurses were. Queen’s Nurses represent us on policy groups and help us with our hugely successful shadowing programme, where policy makers get to see nursing firsthand in the community. We are hugely proud of each and every Queen’s Nurse and sincere thanks are given to our friends at the National Garden Scheme, who through their generous annual grant, enable us to run the vibrant Queen’s Nurse network.

The NGS Elsie Wagg Innovation Scholarships went from strength to strength during 2023, and we welcomed another five projects focused on gardening and health. It was excellent to hear about some of these projects during our 2024 All Queen’s Nurse Day. In addition to supporting the Elsie Wagg Scholarships, our friends at the National Garden Scheme also came to our rescue when funding for several of our networks was withdrawn. This support has enabled us to continue providing the Community Children’s Nurse Network, Long Covid Nurse Group, Homeless and Inclusion Health Practitioner Network and to develop further the General Practice Nurse Education Network. These networks, alongside our Care Home Nurse Network, Infection and Prevention Control Champions Network (both funded by the Department of Health and Social Care) and the Community Nursing Research Forum (funded by the National Institute for Health and Care Research) act as resource hubs for a thousands of nurses and other practitioners, encouraging the dissemination of good practice and supporting staff in their roles.

2023 saw the Institute launch its short film on International Nurse Recruitment featuring stories from nurses from India, South Africa and the Philippines who have come to support community nursing services in the UK. The film reflects the cumulation of work with NHS England supporting international recruitment to community nursing services.

• “ Queen’s Nurses are our greatest asset; they are the modern-day ambassadors for the Institute as the original Queen’s Nurses were; they represent us on policy groups and help us with our hugely successful shadowing programme, where policy makers get to see nursing firsthand in the community. We are hugely proud of each and every Queen’s Nurse. Professor John Unsworth OBE, Chair of Council

QNI Annual Report and Accounts Year to 31 December 2023 7

Above:

Queen’s Nurses at Eton College which opened for the National Garden Scheme

Our two highly successful leadership programmes: the Executive Nurse Leadership Programme and the Aspiring Leaders Programme continued during 2023. Our fantastic team delivered two cohorts of the Aspiring Leaders Programme as well as completing programmes which had started in 2022. Since their launch in 2017, we have seen a one hundred percent achievement of all participants successfully completing these programmes, with a zero-attrition rate and the majority securing more senior positions before the end of the programme. Thanks go to the whole team who support, design and deliver these hugely successful programmes.

Our nursing team also oversaw both the Elsie Wagg Innovation, Personalised Care Innovation and organisation-funded projects during 2023. Since 1990, the QNI has funded around 350 nurse-led innovative projects across the whole range of community nursing specialisms in England, Wales and Northern Ireland. Sharing the results of these projects helps us to drive improvements in knowledge and practice. The team are to be congratulated for the sustained track record in award winning innovation, mentorship, development and support for nurses.

Towards the end of 2023, we started work on a new organisational membership package designed to support nurses and allied health professionals working in community services through the provision of webinars, leadership support, career development and political / policy leadership. The scheme launched very successfully in March 2024 and will grow and evolve over the next few years to become a core part of our work, extending our reach to all nurses working in community services.

Our vitally important support work continued in 2023. This includes financial assistance, small education grants, telephone support for retired nurses (Keep in Touch – KiT) and our listening service, TalkToUs. The latter provides vital support to nurses who find themselves in need or who are suffering from emotional distress and we are grateful to the RCN Foundation for their support for this work. Our Keep in Touch (KiT) service is particularly poignant as community nurses are aware, perhaps more than most, of the loneliness and isolation which many older people experience. This service supports retired community nurses through befriending support from KiT volunteers, all of whom are Queen’s Nurses. I am always hugely proud of the work of our KiT volunteers, grants advisors and staff in all our ‘support for nurses’ programmes.

Almost last, but by no means least, is the huge contribution my fellow trustees make to The Queen’s Nursing Institute. They give their time, expertise, energy and commitment for free, to ensure that the Institute is well governed and achieves year on year success and improvement for the nurses we serve. During 2023 two trustees, Clare Hawkins and Candace Imison left at the end of their terms of office and in March 2024, Dr Katerina Kolyva and Dr Angela McLernon OBE retired from Council. Huge thanks go to Clare, Candace, Katerina and Angela for their highly valued contribution to the Institute.

As I prepare this foreword to the 2023 annual report, the Institute has just had notification that Her Majesty, The Queen has graciously agreed to become our sixth Royal Patron. Queen Camilla’s patronage continues a line of patronage which stretches back to 1887, when H.M Queen Victoria became the first Patron of the organisation which bore her name. We look forward to working with Her Majesty, The Queen to illustrate the outstanding work carried out in her name by nurses across England, Wales and Northern Ireland.

Professor John Unsworth OBE, QN, RN Chair of Council, The Queen’s Nursing Institute June 2024

8 QNI Annual Report and Accounts Year to 31 December 2023

Report of the Council 31 December 2023

The Council presents its report together with the accounts of The Queen’s Nursing Institute (QNI) for the year ended 31 December 2023.

The accounts have been prepared in accordance with the accounting policies set out on pages 37 to 40 of the attached accounts and comply with the charity’s Royal Charter, applicable laws and Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the United Kingdom and Republic of Ireland (FRS 102).

Objectives and activities

The Queen’s Nursing Institute operates in England, Wales and Northern Ireland.

The Queen’s Nursing Institute is an independent national charity that is dedicated to improving the nursing care of people in their communities and homes.

Our vision is that all people are provided with the best possible nursing care by the right nurse with the right skills in homes and communities, whenever and wherever it is needed.

The values provide the foundation for our work. They reflect the principles on which the QNI was first established by William Rathbone and Florence Nightingale in 1887.

Values

• Partnership: with people, patients, organisations and policy makers, ensuring individuals, families, carers and communities are at the heart of all we do.

• Integrity: living the values and seeing equality and diversity as strengths.

• Excellence: in nursing, supported by innovation and evidence.

• Independence: using evidence and insight to provide an independent voice.

• Advocacy: recognising the contribution of all community nurses.

• Legacy: cherishing the history of the QNI and our long-standing relationship with funders.

Public benefit

In setting and supporting the QNI’s strategy and business plan, the members of Council continue to give careful consideration to the Charity Commission’s general guidance on public benefit.

Strategic Plan 2021-25

The six strategic priorities were published at the start of 2021: https://www.qni.org.uk/wp-content/ uploads/2021/02/Strategic-Plan-2021-2025-1.pdf

These priorities reflect the status of the QNI as a national charity, focussed on excellent nursing care for all people in the community.

Influence

1. Policy Influence and Development: to improve the health and wellbeing of individuals, carers, families and communities by local, national and international policy, including through the use of the nurse’s voice.

2. Data and Evidence: to provide independent intelligence about nursing in the community and primary care that is relevant and needed.

Quality

3. Innovation and Quality Improvement: to improve nursing practice in the community through developing, testing and evaluating innovative approaches to care.

4. Standards: to set national standards for nurse education and practice in community settings, which are recognised across the profession, educators and service providers.

QNI Annual Report and Accounts Year to 31 December 2023 9

Above: District Nurse Zarina Khan with a patient

Voice

5. Role models and Leaders: to develop, promote and support excellent and diverse nursing leaders and role models and to empower nurses to raise their voice and articulate their value.

6. Support for Nurses: to support the wellbeing of all community nurses, whether working or not, by listening and responding to their personal and professional needs.

Outcomes

The Trustees determined that the strategic plan should include a focus on outcomes which would also guide the development of the annual business plan and measures of achievement:

Influence: The QNI is the organisation that is called upon to contribute to national policy development and implementation when shaping nursing services in the context of a wider health and social care system.

Quality: Evidence from the QNI regarding quality improvement and standards is used to inform policy, research, practice and education and is recognised at all levels in the system.

Voice: A diverse community of Queen’s Nurses and others in the QNI networks successfully lead innovation and change, challenge inequalities and make a positive difference to the care of individuals, carers, families and communities.

Context

The QNI has continued to be the voice of community nursing and the leading professional organisation for all nurses working in the community at a time when there has been increased funding constraints in services and education.

The QNI has continued to provide independent data and evidence to influence national policy and the provision of solutions to challenging issues in the delivery of nursing services in the community. For this work, we are highly respected and are increasingly being called on for our knowledge, understanding, unique perspectives and expertise, as well as access to our extensive networks.

Our work on the development of QNI UK wide educational standards for nine fields of practice in community nursing, launched in 2023 and reflecting an advanced level of practice, is unprecedented and has been warmly welcomed by the nursing community. The level of uptake for endorsement of Specialist Practice Qualifications has exceeded expectations in this first year. The stakeholder engagement has been exceptional and we thank all those who have been involved, including the individuals, carers, families and experts by experience who have contributed so enthusiastically to the work.

• “ We have continued to champion the role of nurses working in the community, in primary care and social care, and worked to raise their profile with commissioners, policy makers, media and the public. We have growing evidence that our work is contributing to greater recognition of the indispensable role and impact of community nurses in every field of practice.

Dr Crystal Oldman CBE, QNI Chief Executive

10 QNI Annual Report and Accounts Year to 31 December 2023

Throughout the year, the Council of the QNI has provided the skilled governance and leadership required to support the delivery of the strategic plan 2021-2025 and the annual business plan. Facing financial challenges in the year due to a shortfall of budgeted income, Council also supported a restructure of the QNI senior team and a refocus on diversifying our income streams to enable a secure foundation on which to build our work.

Two members of Council retired in March 2023 - Clare Hawkins and Candace Imison - and two retired in March 2024 - Dr Katerina Kolyva and Angela McLernon OBE. The QNI is very grateful for the considerable time and expertise that they so generously gave during their term of office while also employed full time in very senior roles.

Covid19 – impact on the work of the QNI

At the time of writing this report, the UK is entering the fifth year since the start of the pandemic in March 2020. The consequences of the global pandemic are still being felt today. The Office of National Statistics estimates that 1.9 million people in the UK have symptoms of Long Covid, an increase of 400,000 people in the last 12 months. The QNI Long Covid Nurse Network continues to have relevance in sharing the latest research and best practice examples to enhance patient care.

The QNI team works flexibly, and the majority of our programmes and the annual Award Ceremony are now delivered face to face. The QNI annual conference and the annual Queen’s Nurse conference continues to be delivered online, which enables more people to participate and reduces costs and the carbon footprint.

The activities undertaken by the QNI throughout 2023 to achieve the objectives of the third year of the QNI strategy (2021-2025) are set out in the following section ‘Achievements and Performance’.

Achievements and performance - Impact of the work in 2023

Goal One: Policy Influence and Development

Throughout 2023, the QNI contributed expert community nursing insight to more than 20 national advisory groups and round tables. Our influence can be seen in the outputs of the groups and round tables and in 2024 we plan to measure the extent of our influence.

Our unique networks of experienced nurses and our supportive partnerships with stakeholder groups enables a robust collection of intelligence and data that support and contribute to national policy development and policy influence, in alignment with our strategic goal.

Our Queen’s Nurses continue to provide reliable and expert sources of the lived experience of the impact of policies on the organisation and the delivery of nursing services. This is translated into policy influence by the offer of shadowing experiences for senior policy makers, including politicians and their senior advisors, and this was a highly successful strategy throughout 2023.

The QNI contributed to All Party Parliamentary Groups wherever relevant and continued as a member of a group of professional bodies providing evidence for module three of the Covid19 Inquiry:

https://covid19.public-inquiry.uk/modules/ ‘Impact of Covid-19 pandemic on healthcare systems in the 4 nations of the UK’. The QNI has been able to provide data and evidence collected from nurses during the pandemic to contribute to the inquiry, which gives a clear perspective of the lived experienced of nurses working in the community, including in primary and social care settings.

The QNI annual online conference was delivered in October 2023, with extremely positive feedback from the more than 1500 delegates who participated over the four days of the event. The annual online conference was a gift to all nurses, supported by sponsorship funding. We are grateful to our sponsors and all the speakers who provided such engaging sessions, enabling participants to learn and reflect on new information, the latest research and best practice proposals: https://qni.org.uk/news-and-events/events/qni-annual-conference-2023/

We are particularly grateful to Stephen McGann, actor, and Heidi Thomas OBE, writer of the popular BBC television series ‘Call the Midwife’, for giving so generously of their time and closing the conference on day four.

QNI Annual Report and Accounts Year to 31 December 2023 11

Above:

Dr Crystal Oldman CBE, Chief Executive, The QNI, opening the Awards Ceremony 2023

The QNI is member of the International Council of Nurses (ICN) which provides a platform to influence policy nationally and globally in relation to the aims of the ICN – universal health coverage for all, a vision in which nurses play a critical part as the largest clinical professional in healthcare across the world: https:// www.icn.ch/. As a member organisation, the Chair and Chief Executive attended the biennial ICN congress in Montreal in July 2023, which proved to be a very productive global networking, learning and sharing event. QNI Chair, Professor John Unsworth OBE, was also invited to chair two sessions of the conference and a short QNI film of nursing in the community was shown at main stage prior to the panel session focusing on the contribution of nursing expertise in Primary Care.

Goal Two: Data and Evidence

The International Community Nursing Observatory

The QNI’s International Community Nursing Observatory (ICNO), expertly led by Professor Alison Leary MBE, has had a very productive year.

Nursing in the Digital Age, published in February 2023, focussed on the use of technology to support patients in the home. The report made a number of recommendations based on the findings which overall showed an increasing appetite amongst nurses to engage with digital technologies, but a frustration about the paucity of investment into the hardware being used, the lack of interoperability of software and poor connectivity in some areas of the country. All of which are detrimental to productive and efficient ways of working.

Impact of the Additional Roles Reimbursement Scheme (ARRS) on General Practice Nurses was published in January 2024, after the ICNO led on a survey of General Practice Nurses (GPNs) to collect their experiences following the introduction of the new roles into GP practices. The report, which covers some negative unintended consequences of the impact of the scheme on GPNs, has led to some productive conversations with policy makers in England.

The tenth annual District Nurse education audit was published in 2023, detailing the number of District Nurses (DNs) who have undertaken the Nursing and Midwifery Council (NMC) recordable Specialist Practice Qualification (SPQ) in the UK in the academic year 2021/22. The numbers showed a decline and a significant concern about the future funding of the District Nurse SPQ qualification in the coming years, despite the clear direction of travel being for more care to be delivered in the community.

The QNI audit is being undertaken again in 2024 to track the outcome of the 2022/23 cohort. The report has become an annual reference point nationally for tracking the trends of District Nurse education, in order to influence national education policy and funding to more appropriately match demands within community services.

The data for the ‘District Nursing Today’ report was collected and analysed in 2023. This is a regular survey of District Nursing Team Leaders, which was last published in November 2019. This latest report, based on responses from 1500 District Nurse Team Leaders, is under development and the publication date is planned for June 2024.

Included in the data collection was reference to the impact of the ICNO 2022 publication Workforce Standards for the District Nursing Service. Many provider services have implemented the standards across their organisation and the survey systematically collected the impact data from the perspective of the District Nurse Team Leader.

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A commissioned evaluation of an education programme for GPNs commenced in the summer of 2023 and will continue throughout 2024, following a cohort of GPN students through their yearlong programme in Staffordshire and Stoke on Trent.

The Community Nursing Workforce Population Study data collection continues to be under development. The report will provide a description of the percentage of registered nurses who work in the community, as defined by the setting in which they work. This data does not exist at a national level and includes NHS, social care, GP surgeries, the voluntary, education, local authority and independent sectors. The report will be published in 2024 and will influence the narrative around the size, shape and variety of roles and services in community nursing, as well as increasing the visibility as a career choice, and the impact of a nurse working in the community to impact on the health and wellbeing of the people served.

The findings and recommendations of all our publications are shared in all our networks, at conferences and events and with Directors of Nursing in community providers and senior leaders in the NHS. The QNI will continue to utilise our unique data and insights to influence policy in this way.

Community Nursing Research Forum

The Community Nursing Research Forum delivered masterclasses and webinars throughout 2023. Initially commissioned with seed funding by NHSE, the Forum now has over 850 members, from nurses who have an interest in becoming a researcher, through to those who are active community nursing post-doctoral researchers.

Research Master Classes and webinars have an average attendance of over 120 nurses and the feedback is excellent. A mentoring scheme is being rolled out to support the new and aspiring nurse researchers and clinical academics who are now being mentored by the more experienced nurse researchers.

The QNI is grateful to NIHR for the funding to extend the work of the Forum in 2024, to test its impact in actively supporting community nurses to become Principal Investigators.

• “ This was an excellent session. I’m so glad we have had the opportunity to attend. It makes so much sense with the practical application. Feedback from CNRF webinar

Goal Three: Innovation and Quality Improvement

Community Nurse Innovation Programme (CNIP)

The successful model of supporting innovation projects at the QNI is based on more than 20 years of experience of teaching, learning and supporting nurse-led innovations in practice. The programme is now open each year for funding by individuals, employers and grants from foundations and a number of CNIP cohorts successfully completed in the summer of 2023, including the Personalised Care projects.

In 2023, a grant from the Burdett Trust for Nursing was awarded to support seven nurses to deliver their innovation projects focussed on the care of people with Diabetes. They joined another six nurses leading innovation projects, including five funded by the National Garden Scheme and the QNI as Elsie Wagg Scholars and commenced their programme in March 2024.

The QNI portfolio of completed innovation projects from 2014 to 2022 was independently evaluated in 2023/24. The results are significant and demonstrated the lasting impact of the projects on the communities served, and with 67% continuing after the end of the project year. The impact on the nurses who led the projects are equally powerful, with 50% of those who responded nominated for a local or national award for their work and 50% of those nominated being successful.

• “ All project leads reported that their projects had been successful in improving the lives of the individuals, families, carers and communities involved, with 84% fully meeting, and 16% partly meeting, their aims and objectives. CNIP Evaluation Report 2023/24

QNI Annual Report and Accounts Year to 31 December 2023 13

Above: Maritess Murdoch, North Central London Nurse Educator, with a resident from her CNIP Project GARDEN (Grow, Active, Recharge, Develop, Enrich, Nurture)

Homeless and Inclusion Health Programme

The QNI’s Homeless and Inclusion Health Programme has continued with regular network meetings and the development of resources, supporting nurses working with people experiencing homelessness, refugees and asylum seekers, those who are vulnerably housed, sex workers, Gypsy, Traveller, Roma, Boater and Showmen.

The learning and sharing within the participants of the groups provides rapid solutions and learning which is otherwise challenging as isolated practitioners. Members of the network total over 2000 and they support the QNI in providing data and intelligence for policy makers in NHSE and the Department for Levelling Up, Housing & Communities (DLUCH) in England.

A grant from the Office of Health Improvement and Disparities (OHID) was secured in 2022/23 to fund the development of field specific standards for Inclusion Health Nursing as part of the QNI standards work. Members of the network and experts by experience formed a Standards Reference Group and the standards were completed in September 2023 – the first national standards to have ever been developed for this specialist group of nurses.

The QNI is grateful to the National Garden Scheme for supporting the Homeless and Inclusion Health Programme with a grant to enable the support of the nurses and the programme to continue to thrive and develop in 2024.

• “ In a role which is mostly lone-working, it’s good to be part of a group that is not only supportive but keeps you in the loop with updates and innovative work that others are doing around the country (and beyond).

• HIH Network Member

Community Children’s Nurse (CCN) Network

The QNI Community Children’s Nurse Network continues to develop and now has over 500 members from across the UK.

The network has national recognition for this critical specialist nursing service for children and families in the community and is a resource of intelligence for policy makers and senior nurses working at a strategic level.

The network members, as well as families and children using CCN services have been key to the development of the QNI Field Specific Standards for the Specialist Practitioner Qualification (SPQ) in Community Children’s Nursing which were completed in September 2023. This is the first time that standards have been developed specifically for Community Children’s Nurses that are UK wide and reflect an advanced level of practice. It is significant that more universities are planning to have CCN programmes approved by the Nursing and Midwifery Council and endorsed by the QNI, than have been seen for more than a decade.

14 QNI Annual Report and Accounts Year to 31 December 2023

Long Covid Nurse Network

The QNI’s Long Covid Nurse Network has continued to be a valuable source of sharing practice and learning about the emerging research-based evidence. Six online events took place in 2023 and have been very well evaluated.

The aim of the network, which supports over 700 members, is to use the combined insight, expertise, knowledge and intelligence of the members to inform the Long Covid agenda by defining and shaping the role and contribution of community nurses in supporting people living with Long Covid in the community; raising awareness of the impact of Long Covid service delivery on the community nursing workforce; advocating for the recognition of peoples’ ‘lived experience’ of Long Covid and the impact on their lives; recognising and highlighting carers’ experience of Long Covid and the need for support for this group.

Experts by Experience, including nurses with symptoms of Long Covid, participate in the network events and case studies are documented and collated. The resources and links to the latest evidence continue to be updated and regular newsletters are distributed to members.

• “ Really good talks - the info really resonates both personally and professionally. Long Covid Nurse Expert Group feedback

Internationally Educated Nurses in the Community

The QNI was delighted to continue to support Internationally Educated Nurses (IENs) to settle into work in the community.

A new film was launched by the QNI in May 2023 to show how IENs have settled into their new roles in the community, and to help other IENs to learn more about nursing work in the community in England.

The educational film was funded by NHSE and received a very warm welcome from all stakeholders. Internationally educated nurses have always been a significant part of the health and social care workforce in the UK and it was a pleasure to work with many of them in the delivery of this film.

Goal Four: Standards

The QNI is recognised in the UK for its significant expertise in post-registration community nurse education. The nurses in the QNI team have considerable experience of working in a senior level in higher education, leading and managing programmes, and in senior practice development roles in community and primary care settings.

This level of experience and capability within a professional organisation provides a strong foundation for the development of QNI standards for education and practice.

• “ 2023 had several stand-out moments, but for me, the major achievement was the development and publishing of advanced practice standards for nine fields of community nursing practice. These standards represent the cumulation of our work to develop field specific standards for education, which have moved from voluntary standards to standards which now attract QNI endorsement for educational provision. Professor John Unsworth OBE, Chair of Council

Practice Teaching Standards

The QNI worked on the development of Practice Teaching standards, responding to the demand from employers in the community nursing services sector. The absence of any NMC standards for Practice Teacher has led to the closure of most university-based Practice Teacher programmes in the UK, with no equivalent replacement.

The QNI UK standards for Community Practice Teaching were published January 2023 following extensive consultation and feedback. They have been very well received by all stakeholders. In 2023 the NMC announced

QNI Annual Report and Accounts Year to 31 December 2023 15

Above: District Nurse Claire Stuart with a patient at home

that they would be reviewing the NMC framework for practice supervision and assessment of nurses and it is anticipated that the work undertaken to develop and co-produce the QNI standards for Community Practice Teaching will be helpful in this review.

QNI Standards of Education and Practice to support Specialist Practitioner Qualifications

In July 2022, the Nursing and Midwifery Council published new Standards of proficiency for community nursing Specialist Practitioner Qualifications.

In the absence of standards for specific fields of practice and a shared concern about unwarranted variation, the QNI has worked for the last two years in developing Field Specific Standards to build on the NMC standards, using an internationally recognised framework to reflect an advanced level of practice.

With overwhelming support from employers, practitioners, higher education institutions and academics, the QNI established a UK wide Advisory Group and standards were developed for the following nine fields of practice in 2022/23:

----- Start of picture text -----
Adult Social Care Community Community Learning
Nursing Children’s Nursing Disability Nursing
Community Mental Community Palliative and District Nursing
Health Nursing End of Life Care Nursing
General Practice Health and Justice Inclusion Health
Nursing Nursing Nursing
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The nine sets of standards were published in 2023 and early 2024, with recognition of the significant contribution of the chairs and participants of all nine Standards Reference Groups (SRGs). Key stakeholders, including experts by experience, individuals, families and carers have all participated in the SRGs and the QNI standards could not have been developed without their expert knowledge which was given so generously to this work.

The QNI has developed an endorsement process for universities that develop their SPQ programmes using the QNI standards. In early 2024, 25 universities had requested to use the QNI standards for the development of SPQ programmes, incorporating 52 fields of practice. The endorsement process has been welcomed as a mark of programme quality and it is anticipated that this will expand as more fields of practice are added to NMC approved SPQ programmes.

It is significant that new SPQ programmes are being developed for Community Mental Health Nursing, which will directly support the workforce plans to support and strengthen the Mental Health workforce.

16 QNI Annual Report and Accounts Year to 31 December 2023

In addition, new fields of practice identified by the work of the QNI include Adult Social Care Nursing and it is pleasing to see the six universities are developing the programmes.

Association of Academic General Practice Nurse Educators (AAGPNE)

The Association of Academic General Practice Nurse Educators (AAGPNE) is now in its fifth year. It is increasingly recognised as the national body for General Practice Nurse educational expertise, with 73 Members and 33 Associate members from across the UK.

The network has supported the development of the QNI field specific standards for General Practice Nursing and eight universities have signalled that they are seeking endorsement from the QNI, having developed their GPN SPQ programme using the QNI standards.

As a collective voice for general practice nursing, the AAGPNE is able to articulate a national standard for education throughout the GPN career and is a forum for sharing and learning across the academic institutions, in addition to influencing policy in education and practice.

Meetings of AAGPNE members were held quarterly online in 2023, providing an opportunity for professional debate, sharing of best practice, innovations, quality assurance processes, challenges and solutions in GPN education. AAGPNE is co-chaired by the lead for Primary Care at the QNI and a web-based resource of educational and practice resources for GPNs continues to be developed – the General Practice Nurse Education Network (GPNEN).

The QNI is grateful to the National Garden Scheme for committing to support the development of GPNEN in 2024 so that it can become a vibrant online network for all GPNs and will offer network meetings for all GPNs and updates through regular newsletters.

Bournemouth University: Support for GPN programmes

The QNI has continued to provide support to Bournemouth University for the General Practice Nurse (GPN) Fellowship programme and the programme for GPNs new to General Practice. Over the last four years hundreds of GPN students have been supported virtually by the Assistant Director of Nursing Programmes, providing the QNI with an excellent insight into the experiences of nurses new to General Practice, which then informs our policy influencing work.

Goal Five: Role models and Leaders

Queen’s Nurses

The QNI benefited from a substantial grant from the National Garden Scheme (NGS) to continue the work of the QNI in developing and supporting an increased number of Queen’s Nurses (QNs) in 2023.

The applications resulted in 564 new Queen’s Nurses being awarded the title, bringing the total to almost 2500 on the active register. The annual QNI Award Ceremonies took place in December 2023, with a ceremony in the afternoon and the evening – with more than 1000 awardees and guests. There was an option to join remotely which proved to be very successful.

The annual Queen’s Nurse Day entitled ‘The People We Serve’ took place in March 2023 and was attended by 522 QNs. There were a wide range of speakers and the day was very well evaluated.

Regional QN meetings have continued mostly virtually and have given the QNI team and the Queen’s Nurses the opportunity to participate in a way that might not have been possible with the travelling challenges and additional time commitment and cost associated with a face-to-face event. Regional meetings took place in person in Wales and Northern Ireland with members of the QNI team and some regions are experimenting with introducing one face to face meeting in the year.

The QNI continued to support Queen’s Nurses to make a significant contribution to national work in England, including involvement in national consultations, round tables and advisory groups. For example, throughout 2023 two Queen’s Nurses have been the co-chairs of the NHSE Clinical Reference Group for the national community nursing programme.

QNI Annual Report and Accounts Year to 31 December 2023 17

Above:

New Queen’s Nurses at the Awards Ceremony in 2023

Recognition of the work of Queen’s Nurses was also seen in the national honours awarded in the summer to a number of Queen’s Nurses and QNI Fellows.

In July 2023, in celebration of the 75th anniversary of the NHS, the Nursing Times announced the 75 most influential nurses in the history of the NHS. There were nine Queen’s Nurses, including the Chief Executive of the QNI, Dr Crystal Oldman CBE, and seven QNI Fellows, including Dame Professor Elizabeth Anionwu OM, Vice President of the QNI.

In December 2023, Dr Crystal Oldman was awarded the Gold Badge of the Institute, the QNI’s highest award. It is awarded by the Trustees ‘in recognition of conspicuous and distinguished service rendered to the Institute’.

Executive Nurse Leadership Programme

The QNI is very grateful to the NGS for supporting a fifth cohort of Queen’s Nurse Executive Leaders who completed the six-month long programme in February 2024. The impact of the Executive Nurse Leadership programme is significant, with the careers of participants accelerated and enhanced as a direct result of their growth and development on the programme. NGS Chief Executive George Plumptre meets with every cohort and shares the NGS vision and aspiration for Queen’s Nurses to be aiming for senior positions in the health and social care systems in the UK. This is beginning to be seen now, with a QN from the first cohort appointed as Chief Nurse of the UK Blood and Transplant Service in 2022.

Throughout 2023, the leadership team has worked with previous participants to develop the alumni offer for the QN Executive Leaders, who provide considerable mentorship and support for those who are joining successive programmes. This will be launched in 2024.

• “ Feel inspired today about my ability to develop personally and learn from others. Executive Nurse Leader feedback

Aspiring Nurse Leaders Programme (renamed ‘Ambition to Lead Programme’ in 2024) Our successful Aspiring Nurse Leaders programme is very well established and provides an opportunity for community nurses to participate with employer, grant or self-funded places. Two cohorts commence each year in June and November and complete the following year.

With no attrition ever experienced in all cohorts of the programme, the feedback from participants has been overwhelmingly positive and the record has been maintained in 2023 of at least 50% of the participants changing roles to a more senior or more responsible job during the course of the yearlong programme.

The participants on our two cohorts completing in May and October 2023 provided excellent feedback. All suggestions for change are considered and utilised in building the programme for the next cohort. In 2023, the participant evaluations also contributed to the programme review, which is to be launched as the ‘Ambition to Lead Programme’ in 2024.

• “ This course is like no course I have ever done before. I was burnt out and deflated when I arrived on the first day. The course has transformed the way I think and how I feel and I now feel inspired to make changes and pass on my newfound knowledge. Aspiring Nurse Leader feedback

18 QNI Annual Report and Accounts Year to 31 December 2023

Bespoke Professional Development Programmes

In 2023, the QNI was commissioned by Leeds Community Healthcare NHS Trust to deliver a second bespoke professional development programme for community staff nurses and Allied Health Professionals (AHPs) in Leeds. The feedback was excellent and led to the commission of two more cohorts in 2024.

The QNI’s developing reputation for excellence in bespoke programme delivery is predicated on the talents of the nursing delivery team, all of whom have teaching qualifications and much experience in the design and delivery of education programmes, and the highly skilled coordinators who provide all the professional support needed to create a seamless application, recruitment and delivery service.

More commissions have been received for similar professional development programmes in 2024.

Community Nurse Executive Network – CNEN

The QNI is extremely grateful to Hallam Medical for their continued annual grant to support the Community Nurse Executive Network (CNEN). The network provides a safe space for executive level nurses in community provider organisations, large care home and hospice providers, to come together to share challenges and solutions and to be updated from senior leaders in the NHS and social care.

Launched in 2016, CNEN is now in its eighth year of supporting executive nurse leaders. It is established in the sector as a valuable network for sharing best practice, challenges and solutions, while supporting leadership and management practice in community services amongst peers.

The CNEN membership has gained further members throughout 2023, from 219 to 229. Meetings were held monthly throughout 2023 and were chaired by CNEN members: Chair, Helen Mehra, QN, QNI Fellow, QNI Trustee and Vice Chair, Gabbie Parham, QN.

The small group discussions as a safe space for hot topics has been very successful. Feedback from members has been consistently positive on the speakers and the topics covered, both of which are identified by members throughout the year.

Integrated Care Board Chief Nurse Network (ICBCNN)

The QNI is delighted that Hallam Medical extended their support of the QNI senior leaders networks with a grant for the Integrated Care Board Chief Nurse Network which commenced in March 2023.

The Network is a partnership between the NHS Confederation and the QNI, and the Chair of the Network is Louise Patten, NHS Confederation Strategic Advisor and Fellow of the QNI.

The monthly meetings have provided a safe space for support, problem solving and discussion of ‘hot topics’ which remain confidential to the members present.

The QNI is supporting a face-to-face meeting at NHS Expo in June 2024 in Manchester where the ICBCNN members will meet with the QNI team and Hallam Medical Chief Nurse.

Care Home Nurse Network

The QNI is very grateful to the Royal College of Nursing (RCN) Foundation that has supported the QNI’s Care Home Nurse Network and associated activities from January 2020 to December 2022. When the contract ended in December 2022, the RCN Foundation generously permitted the use of an underspend to be used to support the network whilst another source of funding was secured from the Department of Health and Social Care in October 2023.

The network offers an opportunity to share and learn and includes access to a closed Facebook page, online events, the development of a learning repository for Care Home Nurses and a quarterly newsletter.

QNI Annual Report and Accounts Year to 31 December 2023 19

Above: Aspiring Nurse Leadership programme group 2023

The Care Home Nurse network has grown to a membership of 2215 (from 1,785 in 2022). Themed learning events take place quarterly online, on priorities and topics identified by members, and attract around 150 delegates. We have hosted a range of excellent speakers and the network also provides a forum for understanding the impact of new policy initiatives on the social care nursing sector.

The feedback from the participants and members of the Care Home Nurse Network has been outstanding. Importantly, throughout 2023, the network members have been critical in the development of the new QNI field specific standards for Adult Social Care Nursing (ASCN) and six universities are developing the SPQ for ASCN. This is a huge achievement in bringing parity to the Adult Social Care Nursing community with colleagues such as District Nurses.

• “ Thank you very much for brilliant and eye-opening presentations. Care Home Nurse group meeting delegate feedback

Infection Prevention and Control (IPC) Champions

A separate network of Infection Prevention and Control (IPC) Champions in adult social care settings has continued in 2023 to be a vibrant and growing network, now in its third year of delivery.

The network has grown from 1,385 members in 2022 to 1700 in 2023 and attracts up to more than 200 delegates at events, clearly fulfilling a need in the sector. The member newsletters provide updates on all policies related to IPC and examples of best practice. The feedback from network members, which include nurses and care staff in adult social care settings, is excellent and further funding will be sought to continue with the network beyond the current year’s funding from the Department of Health and Social Care which finishes in 2024.

• “ Thank you to everyone, it has been very informative. Some interesting ideas to bring to work. IPC meeting delegate feedback

Goal Six: Support for Nurses

Financial hardship grants

Grant applications have been increasing throughout the year, and other grant giving charities for nurses have seen a similar pattern. This is reflected in the largest amount of funding for single grants ever awarded at £50,000 in response to new applications in 2023. Overall, a total of 282 grants were issued to retired and working community nurses.

We continued to receive applications for nurses whose lives have been impacted by Long Covid and where appropriate, CHSA funding continued to be used for grants alongside the QNI 1965 fund. Repeat CHSA grants are awarded where the person has a long-term condition, such as Long Covid which impacts on the ability to work and earn income.

• “ As a nurse of nearly 23 years, I’ve never fortunately needed to take sick leave, and never had extended time off. I’m a hard-working full-time nurse so was slightly embarrassed to reach out to charities. I’m humbled and super grateful for a grant. Thank you all kindly. Financial Assistance recipient

20 QNI Annual Report and Accounts Year to 31 December 2023

Another reason for the increase in grant applications is the increased cost of living, which exceeded pay rises, and the fuel increases in particular continue to impact on heating homes. Many of our beneficiaries were also in extremely challenging and tragic circumstances in themselves or in relation to family members, including domestic violence and life-limiting illnesses.

The difference that the QNI funding makes to the nurses who are experiencing often extremely complex and challenging situations in their lives is significant. The process is responsive and person-centred, and recipients often report directly to the Grants Manager that the QNI funding provided a lifeline.

We are very grateful indeed to the two very experienced QNI Fellows who provide a consistent Grant Advisor function, confirming the amount to be given in financial assistance following receipt of a detailed report by the Grants Manager.

The QNI is delighted also to be working with the Company of Nurses Charitable Trust in administering their financial hardship fund for community nurses to the value of £5,000 annually, an agreement which commenced in 2019. This has enabled even more nurses to be supported and the QNI is pleased that this continued in 2023 with a further grant of £10,000 for distribution. The QNI also administers the Hertfordshire Community Nurses’ Charity Welfare Grant applications, making recommendations for the grants to be awarded, where appropriate.

“ I am almost lost for words and am shaking with emotion. Whenever we have sought help from organisations for various reasons regarding our financial situation it has been so hard. You feel as though you have to bare your soul and it’s so incredibly difficult. We thank you so very much for all your help and kindness. This is really a big help for our family. Thank you very very much. Financial Assistance recipient

Education grants

The QNI awarded education grants in 2023 to nurses completing the QNI Aspiring Leaders and Executive Leadership programmes, totalling £3000.

Since 2019 the QNI has been supported by the Company of Nurses Charitable Trust to administer their education grant specifically for nurses working with people experiencing homelessness, from the Chantry Robinson Fund: Donations and Funds - The Company of Nurses. Two places for the Inclusion Health course at University College London (UCL) were successfully funded in 2019, 2020 and 2021. In 2022, the Inclusion Health Programme at UCL was closed and in 2023, one nurse was supported to undertake a similar Inclusion Health Programme via the University of Edinburgh.

The Company of Nurses also awarded the QNI grant funding for two places on the 2023 cohorts of the Aspiring Leaders programme for nurses working in Inclusion Health services.

One of the nurses supported by the Company of Nurses to undertake the Aspiring Leaders programme in 2022 was awarded the Burdett Nursing Trust award in May 2023 for her teamwork in Inclusion Health (Primary Care award category) and she was then named as the overall winner of all categories.

Education Prizes

Philip Goodeve-Docker Memorial Prize

The Philip Goodeve-Docker Memorial Prize was established in memory of a young man who in 2013 embarked on a fundraising challenge to cross Greenland to raise money for the QNI. His grandfather had been a QNI Council member and Treasurer for over 25 years. Tragically Philip lost is life in the endeavour but his family and friends raised over £60,000 for the QNI in his memory. The memorial prize is awarded for outstanding achievement in the District Nursing SPQ at every university in England, Wales and Northern Ireland where the programme is

QNI Annual Report and Accounts Year to 31 December 2023 21

Above: Saffina Pennant receiving the Philip Goodeve-Docker Memorial Prize certificate from Professor John Unsworth OBE at the Awards Ceremony in 2023.

offered. Many prize winners have subsequently become Queen’s Nurses or have continued their affiliation with the charity in other ways.

Dora Roylance Memorial Prize

The QNI received a legacy of £21,792 from a retired QN who died in 2015. The specification was that it was to be used for the support of Health Visitor education. A Dora Roylance Memorial Prize has been created which is similar to the Philip Goodeve-Docker Memorial Prize; it is for the most outstanding achievement for every student Health Visitor in every university offering the Health Visitor programme in England, Wales and Northern Ireland. Taking into consideration the number of universities offering the Health Visitor programme and the total of the fund, the award of prizes is likely to last approximately 15 years.

Ellen Mary Memorial Prize

The Ellen Mary Fund was established in 2019 from a legacy received from the family of a Queen’s Nurse, whose mother, Ellen Mary left a legacy of £5,000 to support an annual prize for General Practice Nurse (GPN) students undertaking their NMC approved GPN specialist practice qualification. The memorial prize is awarded for outstanding achievement in the General Practice Nursing SPQ at every university in England, Wales and Northern Ireland where the programme is offered.

William Rathbone X Annual Award

In 2023, the William Rathbone X Award was established, in memory of William Rathbone X who was a trustee of the QNI for 48 years and who sadly died on 31.12.22. As the great-great-grandson of the founder of the QNI, William (Bill) Rathbone X made a significant and enduring impact on the work of the QNI and his legacy can be seen in the work delivered by the QNI today. The Award is sponsored by Bill Rathbone’s daughter Lucy Addyman and son-in-law Nick Addyman, QNI Trustee.

The Award is for the most outstanding Executive Nurse of a community services provider and nominations are judged by a panel of experts. In 2023, the award was given to Michelle Bateman, QN and Executive Director of Nursing at Derbyshire Community Health Services NHS Foundation Trust. The ceremony took place in London in June 2023 and was attended by Trustees, Fellows, key stakeholders, nominees and Queen’s Nurses. The Award was followed by the Annual William Rathbone X lecture, given by Professor Alison Leary MBE and was live streamed to a wider audience.

‘Keep in Touch’ programme

The ‘Keep in Touch’ programme provides an opportunity for retired Queen’s Nurses and other socially isolated community nurses, to be supported by a volunteer Queen’s Nurse via the telephone. The initiative was originally funded by a legacy from a retired Queen’s Nurse and 2023 was the seventh year of a very successful service.

36 volunteers (2022 – 36) have been ‘matched’ to a beneficiary of the service and they provide a telephone befriending service either weekly or fortnightly to 37 beneficiaries. In total there are 58 beneficiaries of the service, of which 21 are supported by the ‘Keep in Touch’ programme manager, with additional support from a volunteer who retired from the QNI team at the end of 2022 and began this work afterwards.

22 QNI Annual Report and Accounts Year to 31 December 2023

The Keep in Touch service has continued to be evaluated extremely positively, with excellent feedback from both the beneficiaries and the volunteers. The annual volunteer update days were held online on two Saturday mornings in November 2023 and 24 volunteers attended across the two days. The sharing of experiences and challenges during these two days provided moving accounts of the value of the service, to both the beneficiaries and the volunteers.

In addition to these two online meetings, volunteers were offered the opportunity to meet in London in May 2023. This provided networking, updating and meeting with the Chief Executive and wider team – and an opportunity for the QNI to thank them for their considerable expertise and volunteering their time so generously every week.

• “ I cannot believe we have been speaking for six years – my Volunteer has become a very special telephone friend. KIT contact

TalkToUs

The now established TalkToUs listening service provides support all nurses in need of emotional support from trained listeners.

Led by the Keep in Touch manager, the service responds to every request for a call. The service is anonymous and the feedback at the end of an hour long 1:1 call is consistently positive, with nurses saying that they feel more confident to manage the challenges facing them.

Beneficiaries are also provided, wherever appropriate, with signposting to other support services, including psychological support services. For some, referral to the QN financial assistance service has been appropriate, in order to explore an additional source of support.

• “ Thank you for being there to listen whilst I offloaded. It has been so helpful and a real lifeline when I most needed it. Talk To Us feedback

Organisational development

The role and contribution of volunteers

The QNI is very grateful to the large number of volunteers who support a range of areas of work within the charity. The QNI would like to thank most sincerely all our volunteers for their significant contribution to the work of the charity throughout 2023.

QNI volunteers include all members of Council, project advisory groups, standards reference group members, QN application assessors, members of panels who review awards and grant applications, befrienders supporting the ‘Keep in Touch’ programme, and those who support policy consultation work.

In 2023 Queen’s Nurses also continued to contribute significantly to the policy work of the QNI as volunteers, attending QNI focus groups, Department of Health and Social Care advisory groups and round table discussions for national work and with arm’s length bodies on behalf of the QNI.

Fellows of the QNI continued to contribute to and support the work of the QNI in 2023, providing ongoing mentorship during and after the Aspiring and Executive Leadership programmes, and several have provided personal advice and support to the Chief Executive.

Council members collectively gave more than 1,000 hours of their time attending meetings, chairing advisory groups and participating in QNI events, including the annual conference and the annual award ceremony.

During 2023, it is estimated that more than 200 individuals made contributions to the work of the QNI, totalling in excess of 3,500 hours of voluntary work.

QNI Annual Report and Accounts Year to 31 December 2023 23

Above:

Queen’s Nurse and Advanced Nurse Practitioner, Teresa O’Nwere-Tan, with a patient

The QNI is deeply grateful and indebted to all its volunteers, including Queen’s Nurses, QNI Fellows, ‘Keep in Touch’ befrienders, grants advisors and other stakeholders for their expertise and commitment to the work of the QNI and giving their time so generously. The QNI standards could not have been developed without the expertise of the many volunteers in each of the field specific standards reference groups and in particular those who contributed as individuals, families, carers and experts by experience.

Key financial policies of the QNI

Community Nursing Innovation Programme – direct funding of projects

The QNI makes awards to support individual projects run by community nurses. The projects are selected on a competitive basis; those selected demonstrate the greatest innovation and potential impact on the care of individuals, families, carers and communities. The projects run for a year and the scheme offers a professional development programme for the project leaders in addition to the grant to enable project delivery. The opportunity is often dependent on funding being received to support the programme and when available, details of the programme and the application process are set out on the QNI website innovation programme pages. The QNI now offers self and employer funded places on the programme.

Grants

The QNI provides financial assistance to nurses who have worked or who are currently working in the community or primary care environment and to retired Queen’s Nurses (nurses working in the community who were trained by the QNI between 1887 and 1967).

The majority of the beneficiaries are nurses who are no longer able to work because of illness, age or disability. Applications are accepted from nurses, their friends, family or professionals and voluntary organisations supporting them (with the applicant’s consent). An application form detailing eligibility, health and housing status, income, savings and expenditure must be completed, together with a description of what level of financial assistance is being sought. This information is checked by staff before being presented to the grants advisors for consideration. Information on other relevant charities that may be able to assist in their case is also supplied to successful and unsuccessful applicants.

There have been three grants advisors in 2023: Nick Addyman (Trustee and Chair of the annual Support for Nurses review), Sally Hawksworth (QNI Fellow and Respiratory Nurse Specialist) and Sue Talbot (QNI Fellow and service commissioner). Applications for grants are considered by one of the three Grants Advisors as part of the assessment process.

The QNI will consider all types of applications for single grants. In a diminishing number of cases, assistance is provided in the form of regular grants and on-going gifts from year to year. The gifts are dependent on the availability of funds and are not regarded as a regular commitment.

A system of random audits of a sample of the QNI’s grants records forms part of the internal financial controls each year, to safeguard against fraudulent claims or administration of applications. The audit was conducted in the spring of 2023 by Sue Talbot, Grants Advisor, with a satisfactory outcome which was reported to Council.

24 QNI Annual Report and Accounts Year to 31 December 2023

Investment policy

In keeping with charity law, the QNI’s investment strategy aims to maximise income and capital, within acceptable levels of risk.

The QNI’s investments are managed by Rathbone Investment Management Limited, which operates within guidelines set by the Council and the fund manager meets with the Finance Committee at least twice a year.

Currently, the only ethical constraint is that the fund should not invest in any companies which derive a significant part of their revenue directly from the manufacture or sale of tobacco-related products.

In April 2023, following a procurement process, the QNI commissioned Asset Risk Consultants (ARC) to undertake a review of our investments with Rathbone and following extensive consultation with Trustees, to draft a revised investment policy. This work is being overseen by the Honorary Treasurer and the Head of Finance and will be completed in the summer of 2024.

The revised investment policy has been discussed and it is anticipated that the final copy will be agreed by Council in June 2024 and any changes implemented by January 2025.

The QNI investments are reviewed monthly by the Head of Finance and the Honorary Treasurer. In 2023, the performance of the investments was considered to be satisfactory both in terms of capital and investment.

Given the developments regarding the importance of Environmental, Social, and Governance (ESG) as the three central factors in measuring the sustainability and societal impact of an investment in a company or business, throughout 2023, Council has been in dialogue with the Rathbone investment manager on the approach to ESG and the emerging policy within Rathbone. The outcome of the discussions will contribute to the revised QNI investment policy.

Members of Council have carried out their annual assessment of the level of the QNI’s reserves, taking into consideration the QNI’s working capital requirements and liquidity needs, the future expansion of its work, and a contingency provision. They are also mindful of the QNI’s responsibility to honour the investment made by partners and scholars and participants in schemes and other professional development initiatives that extend for more than one year.

In 2015, it was agreed that the recommendations made by the Finance Committee, and agreed by Council, regarding the reserves policy and the use of expendable endowment should be ‘codified’ in a financial strategy to align with the QNI strategy (2017-2020).

It was agreed by Council in 2021 that the principles upon which the financial strategy was based continue to be relevant to the delivery of the new QNI strategy 2021-25:

1. The expendable endowment fund should be preserved at a level which ensures the generation of income sufficient to cover a level of core costs, such as the lease and service charge costs, and so enable the longterm viability of the QNI.

2. The level at which the expendable endowment is to be preserved over and above the level required in 1 above will be determined by Council year on year. (See also note 21 for further details).

3. The expenditure of the restricted District Nurses 1965 Fund (welfare) will be reviewed annually in the context of the distribution of financial assistance currently being greater than the annual investment income.

4. Council will determine each year the levels of expendable endowment fund needing to be transferred to general funds, if any, to be used to support QNI activity.

Financial review

The financial year resulted in net expenditure (before investment gains) of £551,804 (2022 – £466,848). This comprised of net expenditure on unrestricted funds of £385,918 (2022 – (net expenditure of £134,425), net expenditure on restricted funds of £165,886 (2022 – net expenditure of £332,423) and net income on endowment funds of £nil (2022- £nil).

QNI Annual Report and Accounts Year to 31 December 2023 25

Above:

Queen’s Nurse and neonatal community nurse, Tammy Franks meeting with a patient and her newborn baby

Income

Income for the year totalled £1,383,431 (2022 – £1,369,207), 3% higher than 2022. Income from donations and legacies was £472,185 (2022 – £342,523) an increase of 38%, and income from charitable activities was £576,283 (2022 – £701,516), a decrease of 18%. Investment income and interest receivable was £334,963 (2022 – £325,168) for the year and this continues to provide an essential element of the QNI’s core funding.

Expenditure

Expenditure for 2023 totalled £1,935,235 (2022 – £1,836,055), an increase of 5% on 2022. This increased expenditure represents the significant investment the QNI is currently making in launching Field Specific Standards for Specialisms in Community Nursing, other organisational development, an increase in Queen’s Nurse numbers and the growth of wider networks.

Investments

The QNI’s portfolio of investments and cash held for investment had a market value at 31 December 2023 of £11,029,693 (2022 - £11,185,126). Income from the portfolio for the year was £332,857 (2022 – £323,365), and net investment gains on the revaluation and disposal of investments were £396,766 (2021 – net losses of £1,164,506).

Reserves

At the year-end, the charity held ‘free reserves’ of £585,151. These free reserves are now in excess of the six to nine months of committed unrestricted expenditure required by the QNI’s reserves policy. The Council is content with this position and considers that it provides flexibility given the organisational development and the wider investment being made by the QNI as well as the war in Ukraine and current inflationary pressures (see earlier in this report).

Fundraising

The QNI does not employ a professional fundraiser. Bids or project grants are developed and submitted by the Chief Executive with support from key members of the team including the Head of Finance and the Directors of Nursing Programmes.

Sponsorship opportunities for QNI activities are explored as appropriate and Hallam Medical continues as a regular sponsor of the Community Nurse Executive Network (CNEN) and in 2023, Hallam Medical sponsored the Integrated Care Board Chief Nurse Network. In 2023, the annual online conference was sponsored by Hallam Medical and Teva UK. A separate sponsored learning event was funded by Yarra.

The QNI does not seek to raise funds from the public. A number of Queen’s Nurses provide regular donations to the QNI, as do some members of Council. Queen’s Nurses are also encouraged to raise retailer donations through the use of software platforms such a ‘EasyFundraising’. The QNI has received no complaints about this or any other approach to fundraising.

Structure, governance and management

Governing document

The QNI is registered as a charity under the Charities Act 2011 and operates in England, Wales and Northern Ireland. It was founded in 1887 and was granted its Royal Charter in 1889. Supplemental Charters have been granted in 1904, 1928, 1958, 1973 and 2008. Under the Charters, the members of Council (i.e. the Trustees) are incorporated as a body.

26 QNI Annual Report and Accounts Year to 31 December 2023

Council members

There are 15 members of Council, some with clinical backgrounds and others with expertise in communications, law, business, finance and the management of charities.

In March 2023, two members retired after one term of office, due to work pressures: Candace Imison and Clare Hawkins. Another two members retired in March 2024, again due to work commitments: Katerina Kolyva and Angela McLernon OBE.

Recruitment and appointment of Council members

Under the constitution of the QNI, the Patron may nominate and appoint up to four people who act as ex-officio members of the Council. All other members of Council are nominated by existing Council members or recruited through agreed procedures before being approved by the Patron.

Each year, the QNI Chair undertakes 1:1 interviews with each of the members of Council and discusses their individual contribution to Council and any feedback they have on the development and the governance of the QNI. This is also an opportunity to review gaps in the skills and expertise of Council in relation to the ongoing development needs.

Induction and training of Council members

All new Council members are supplied with the Council members’ handbook as well as relevant papers, policies and publications from the QNI.

New members of Council are invited to meet the Chair and Chief Executive for a 1:1 induction soon after appointment. The new Trustees are also invited to meet with key QNI staff informally. A few months after their appointment, the Chair meets with them again to seek their views on the QNI in general and Council in particular. New members of Council are also encouraged to visit the QNI’s offices, as appropriate, to meet individual staff members and find out more about specific areas of work.

Members of Council do not receive remuneration in respect to their services to the QNI. They are provided with the opportunity to apply for reimbursement for travel expenses when attending Trustee meetings.

Staffing of the QNI and key management personnel

The key management personnel of the QNI, responsible for directing and controlling, running and operating the charity on a day-to-day basis, comprise members of Council together with the five members of the Senior Leadership Team of the QNI: the Chief Executive, Director of Nursing Programmes (Innovation and Policy), Director of Nursing Programmes (Leadership and Standards), Head of Communications and Head of Finance.

The Chief Executive has overall responsibility for day-to-day leadership and operational matters, and reports to Council on a regular basis.

All staff have six monthly performance appraisals against objectives linked to the business plan for the year. The QNI Staff Handbook provides information on internal policies and ways of working to all staff. The Handbook was revised in 2016, in line with new employment legislation, with support from the QNI solicitors, Russell-Cooke and is updated annually in accordance with any changes of legislation and examples from the charitable sector of best practice in people management. The handbook was reviewed in 2022 to accommodate the changes in flexible working introduced in the year.

When advertised, the salaries of all staff, including key management posts, are determined by the scope of responsibilities of the various levels of post, such as coordinator, events manager and the leadership team.

Risk management

Major risks to which the QNI is exposed, arising from its own work and from external contingencies, are reviewed regularly by the Finance Committee and Council, and systems or procedures are in place to manage, and where possible mitigate, those risks.

QNI Annual Report and Accounts Year to 31 December 2023 27

Above: Queen’s Nurses Kendra Schneller and Fawn Bess-Leith at the National Garden Scheme’s Chelsea press day

The QNI’s risk register is maintained by the Chief Executive and is reviewed by Council at every meeting. In 2021, the QNI introduced the concept of risk tolerance, and the following examples are those which are still considered major risks, with controls in place.

People

Risk: “The Charity loses a key member of staff”

Controls: “Skills will be ‘bought in’ as necessary in the absence of permanent staff e.g. finance and communications. Staff will in some circumstances be expected to act both ‘up and down’ within the organisation. Finance, welfare and admin procedure manuals are available to help temporary staff. The QNI financial procedures handbook is updated by the QNI leadership team when any changes are made.”

This was tested in 2023 when a new Directors of Nursing Programmes (Leadership and Standards) was appointed after a gap of six months. Before their appointment, their work was covered expertly by a senior member of the team who increased their hours to accommodate the additional work. A handover period was also supported.

Business Continuity

Risk: “The QNI IT system is compromised by viral attacks. Day-to-day business is compromised”. Controls: “Anti-virus software is updated regularly by QNI contracted IT company. Quarterly ‘housekeeping’ visit to QNI offices by named individual from QNI contracted IT maintenance company and helpline available in office hours.”

In 2024, the QNI is planning to undertake an assessment of our digital systems and processes, using the government recommended approach of ‘Cyber Essentials’.

Finance and Fundraising

Risk: “The charity’s investments fall significantly in value”

Controls: “Use professional investment managers with delegated powers. Investment manager appointment is reviewed every three years. The charity has a written investment policy which is agreed by the Council and communicated to the investment managers. It is reviewed by the Finance Committee annually. Hold regular meetings with the investment managers at which investment performance is monitored against the investment policy and against market averages. Diversify income streams so that fundraising can compensate for investment income shortfalls. Maintain sufficient reserves which are regularly reviewed by the Finance Committee. Each quarter the Finance Committee compares actual returns with a) the income target set by Council and b) the WM/R Index and c) QNI tailor-made benchmark. The Investment Manager attends the Finance Committee meeting twice yearly. The benchmarks are reviewed annually at the Finance Committee with the investment manager and with the Finance Committee”.

In 2023/24, the QNI commissioned a review of our investment management service by Asset Risk Consultants (ARC) and we will be continuing to invest with Rathbones.

Queen’s Nurses

Risk: “The QN community does not adequately reflect the diversity of the population of nurses in the community”

Controls: The QNI actively targets nurses from the Global Majority working in the community to encourage applications for the title of Queen’s Nurse. Currently, the network of QNs does not reflect adequately the

28 QNI Annual Report and Accounts Year to 31 December 2023

population of nurses working in the community. A review of the application and assessment process took place again in 2023 and a revised application form is in place for 2024. Videos and testimonials from Global Majority QNs were created in 2023 to support more applications from Global Majority colleagues, following a meeting with QNs in March 2023. All existing QNs have been asked to champion the application of a Global Majority colleague. All applicants for the title of Queen’s Nurse are requested to complete an ‘Equality & Diversity’ form so that Global Majority heritage might be known (but not all applicants complete this). The diversity of the QN community will continue to be closely monitored in 2024 and further actions taken as required.

The Council’s responsibilities statement

The Council (who are the Board of Trustees of the charity for the purposes of charity law) is responsible for preparing the Report of the Council and accounts in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice)

Charity law and the QNI’s Royal Charter require the Council to prepare the accounts of the QNI for each financial year which give a true and fair view of the state of affairs of the QNI and of its income and expenditure for that period. In preparing accounts giving a true and fair view, the Council should:

• select suitable accounting policies and then apply them consistently;

• observe the methods and principles in the Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the United Kingdom and Republic of Ireland (FRS102);

• make judgements and estimates that are reasonable and prudent;

• state whether applicable United Kingdom Accounting Standards have been followed, subject to any material departures disclosed and explained in the accounts; and

• prepare the accounts on the going concern basis unless it is inappropriate to presume that the QNI will continue in operation.

The members of the Council are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the charity and to enable them to ensure that the financial statements comply with the Charities Act 2011, applicable Charity (Accounts and Reports) Regulations and the provisions of the charity’s governing document. They are also responsible for safeguarding the assets of the charity and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

Signed on behalf of the Council

Professor John Unsworth OBE Chair of Council Date: 26 June 2024

QNI Annual Report and Accounts Year to 31 December 2023 29

Independent auditor’s report to the members of the Council of The Queen’s Nursing Institute

Opinion

We have audited the accounts of The Queen’s Nursing Institute (the ‘charity’) for the year ended 31 December 2023 which comprise the statement of financial activities, the balance sheet, the statement of cash flows, the principal accounting policies and notes to the accounts. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including Financial Reporting Standard 102 ‘The Financial Reporting Standard applicable in the UK and Republic of Ireland’ (United Kingdom Generally Accepted Accounting Practice).

In our opinion, the accounts:

• give a true and fair view of the state of the charity’s affairs as at 31 December 2023 and of its income and expenditure for the year then ended;

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

• have been prepared in accordance with the requirements of the Charities Act 2011.

Basis for opinion

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

Conclusions relating to going concern

In auditing the accounts, we have concluded that the members of Council’s use of the going concern basis of accounting in the preparation of the accounts is appropriate.

Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the charity’s ability to continue as a going concern for a period of at least twelve months from when the accounts are authorised for issue.

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

Other information

The members of Council are responsible for the other information. The other information comprises the information included in the Annual Report and Accounts, other than the accounts and our auditor’s report thereon. Our opinion on the accounts does not cover the other information and we do not express any form of assurance conclusion thereon.

In connection with our audit of the accounts, our responsibility is to read the other information and, in

30 QNI Annual Report and Accounts Year to 31 December 2023

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

We have nothing to report in this regard.

Matters on which we are required to report by exception

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

• the information given in the Report of the Council is inconsistent in any material respect with the accounts; or

• sufficient accounting records have not been kept; or

• the accounts are not in agreement with the accounting records and returns; or

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

Responsibilities of members of Council

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

In preparing the accounts, the members of Council are responsible for assessing the charity’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the members of Council either intend to liquidate the charity or to cease operations, or have no realistic alternative but to do so.

Auditor’s responsibilities for the audit of the accounts

Our objectives are to obtain reasonable assurance about whether the accounts as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these accounts.

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

How the audit was considered capable of detecting irregularities including fraud

Our approach to identifying and assessing the risks of material misstatement in respect of irregularities, including fraud and non-compliance with laws and regulations, was as follows:

• The audit director ensured that the engagement team collectively had the appropriate competence, capabilities and skills to identify or recognise non-compliance with applicable laws and regulations;

• We identified the laws and regulations applicable to the charity through discussions with management and Trustees and from our knowledge and experience of the charity sector;

• We focused on specific laws and regulations which we considered may have a direct material effect on the accounts or the activities of the charity. These included but were not limited to the Charities Act 2011; Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable to the United Kingdom and Republic of Ireland (FRS 102) (effective 1 January 2019) and The Code of Fundraising Practice; and

• We assessed the extent of compliance with the laws and regulations identified above through making

QNI Annual Report and Accounts Year to 31 December 2023 31

enquiries of management and those charged with governance and review of minutes of Council meetings.

• We assessed the susceptibility of the charity’s accounts to material misstatement, including how fraud might occur. Audit procedures performed by the engagement team included:

• Making enquiries of management and those charged with governance as to where they considered there was susceptibility to fraud, their knowledge of actual, suspected and alleged fraud; and

• Considering the internal controls in place to mitigate risks of fraud and non-compliance with laws and regulations.

To address the risk of fraud through management bias and override of controls, we:

• Performed analytical procedures to identify any unusual or unexpected relationships;

• Reviewed journal entries to identify unusual transactions;

• Tested the authorisation of expenditure;

• Assessed whether judgements and assumptions made in determining the accounting estimates were indicative of potential bias; and

• Investigated the rationale behind significant or unusual transactions.

• In response to the risk of irregularities and non-compliance with laws and regulations, we designed procedures which included, but were not limited to:

• Agreeing financial statement disclosures to underlying supporting documentation;

• Reading the minutes of Council meetings; and

• Enquiring of as to actual and potential litigation and claims.

There are inherent limitations in our audit procedures described above. The more removed that laws and regulations are from financial transactions, the less likely it is that we would become aware of noncompliance. Auditing standards also limit the audit procedures required to identify non-compliance with laws and regulations to enquiry of the Trustees and other management and the inspection of regulatory and legal correspondence, if any.

Material misstatements that arise due to fraud can be harder to detect than those that arise from error as they may involve deliberate concealment or collusion. We did not identify any irregularities, including fraud.

A further description of our responsibilities for the audit of the accounts is located on the Financial Reporting Council’s website at www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report.

Use of this report

This report is made solely to the charity’s members of Council, as a body, in accordance with section 144 of the Charities Act 2011 and with regulations made under section 154 of that Act. Our audit work has been undertaken so that we might state to the charity’s members of Council 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 members of Council as a body, for our audit work, for this report, or for the opinions we have formed.

Buzzacott LLP Statutory Auditor 130 Wood Street London 28 June 2023 EC2V 6DL

Buzzacott LLP is eligible to act as an auditor in terms of section 1212 of the Companies Act 2006

32 QNI Annual Report and Accounts Year to 31 December 2023

Statement of Financial Activities Year to 31 December 2023

Notes	Unrestricted funds £	Restricted funds £	Endowment funds £	2023 Total funds £	2022 Total funds £
Income and endowments from: Donations and legacies 1 Investment income and interest receivable 2 Charitable activities 3 Total income Expenditure on: Raising funds . Costs of generating grants and donations 4(a) . Management of investments 4(b) Total expenditure on raising funds Charitable activities . Policy Influence and Development 5 . Data and Evidence 5 . Innovation and Quality Improvement 5 . Standards 5 . Role models and Leaders 5 . Support for Nurses 5 . Council approved funds Total expenditure on charitable activities Total expenditure Net expenditure before investment gains Net gains (losses) on investment assets 15 Net (expenditure) income 8 Gross transfers between funds 21 Net movement in funds Reconciliation of funds: Funds brought forward at 1 January 2023 Funds carried forward at 31 December 2023	446,478 300,003 372,300	25,707 34,960 203,983	— — —	472,185 334,963 576,283	342,523 325,168 701,516
	1,118,781	264,650	—	1,383,431	1,369,207
	29,982 48,770	— 3,845	— —	29,982 52,615	72,820 53,017
	78,752	3,845	—	82,597	125,837
	173,755 106,423 147,953 95,813 753,885 148,118 —	— 22,357 70,591 18,522 171,294 143,927 —	— — — — — — —	173,755 128,780 218,544 114,335 925,179 292,045 —	58,669 43,437 393,775 146,127 561,901 272,306 234,003
	1,425,947	426,691	—	1,852,638	1,710,218
	1,504,699	430,536	—	1,935,235	1,836,055
	(385,918) 34,943	(165,886) 29,858	— 331,965	(551,804) 396,766	(466,848) (1,164,506)
	(350,975) 631,000	(136,028) —	331,965 (631,000)	(155,038) —	(1,631,354) —
	280,025 997,405	(136,028) 858,336	(299,035) 9,416,269	(155,038) 11,272,010	(1,631,354) 12,903,364
	1,277,430	722,308	9,117,234	11,116,972	11,272,010

All of the financial activities of the QNI during the above two financial years derived from continuing operations.

*A full comparative statement of financial activities for the year to 31 December 2022 is given on page 34.

QNI Annual Report and Accounts Year to 31 December 2023 33

Statement of Financial Activities (comparative) Year to 31 December 2023

Notes	Unrestricted funds £	Restricted funds £	Endowment funds £	2022 Total funds £
Income and endowments from: Donations and legacies 1 Investment income and interest receivable 2 Charitable activities 3 Total income Expenditure on: Raising funds . Costs of generating grants and donations 4(a) . Management of investments 4(b) Total expenditure on raising funds Charitable activities . Data, evidence and policy influence 5 . Standards 5 . Role models/leaders 5 . Innovation 5 . Providing support for nurses – Support 5 . Providing support for nurses – Education 5 . Providing support for nurses – Keep in Touch 5 . Council approved funds Total expenditure on charitable activities Total expenditure Net expenditure before investment gains Net (losses) gains on investment assets Net expenditure 8 Gross transfers between funds 21 Net movement in funds Reconciliation of funds: Funds brought forward at 1 January 2022 Funds carried forward at 31 December 2022	342,523 292,413 61,446	— 32,755 640,070	— — —	342,523 325,168 701,516
	696,382	672,825	—	1,369,207
	72,820 47,406	— 5,611	— —	72,820 53,017
	120,226	5,611	—	125,837
	101,883 91,906 233,124 49,665 — — — 234,003	223 54,221 328,777 344,110 218,271 24,711 29,324 —	— — — — — — — —	102,106 146,127 561,901 393,775 218,271 24,711 29,324 234,003
	710,581	999,637	—	1,710,218
	830,807	1,005,248	—	1,836,055
	(134,425) (162,898)	(332,423) (64,017)	— (937,591)	(466,848) (1,164,506)
	(297,323) 250,000	(396,440) —	(937,591) (250,000)	(1,631,354) —
	(47,323) 1,044,728	(396,440) 1,254,776	(1,187,591) 10,603,860	(1,631,354) 12,903,364
	997,405	858,336	9,416,269	11,272,010

34 QNI Annual Report and Accounts Year to 31 December 2023

Balance sheet Year to 31 December 2023

Notes	2023 £	2023 £	2022 £	2022 £
Fixed assets Tangible assets 13 Heritage assets 14 Investments 15 Total fixed assets Current assets Debtors 16 Cash at bank and in hand Creditors:Amounts falling due within one year 17 Net current liabilities/assets Total net assets The funds of the charity Unrestricted funds . General funds . Tangible and heritage asset fund 18 . Designated funds 19 Restricted funds 20 Endowment funds 21	93,711 596,126	13,129 70,000 11,029,693	73,013 340,724	14,485 70,000 11,185,126
		11,112,822 4,150		11,269,611 2,399
	689,837 (685,687)		413,737 (411,338)
		11,116,972		11,272,010
		585,151 83,129 609,150		825,760 84,485 87,160
		1,277,430 722,308 9,117,234		997,405 858,336 9,416,269
		11,116,972		11,272,010

Approved by the members of Council and signed on their behalf by:

Professor John Unsworth OBE Chair of Council

Approved on: 26 June 2024

QNI Annual Report and Accounts Year to 31 December 2023 35

Year to 31 December 2023 Statement of cash flows

atement of cash fows Year to 31 December	2023
Notes	2023 £	2022 £
Cash flows from operating activities: Net cash used in operating activities A Cash flows from investing activities: Payments to acquire tangible fixed assets Payments to acquire investments Receipts from disposals of investments Investment income and interest received Net cash provided by investing activities Change in cash and cash equivalents in the year Cash and cash equivalents at 1 January 2023 B Cash and cash equivalents at 31 December 2023 B	(626,868)	(860,083)
	(4,892) (1,506,174) 1,776,690 334,963	(6,563) (1,482,650) 1,297,751 325,168
	600,587	133,706
	(26,281) 676,685	(726,377) 1,403,062
	650,404	676,685

Notes to the statement of cash flows for the year to 31 December 2023.

A Reconciliation of net movement in funds to net cash used in operating activities

	2023 £	2022 £
Net expenditure (as per the statement of financial activities) Adjustments for: Depreciation charge Net (gains) losses on investments Investment income and interest receivable (Increase) decrease in debtors Increase (decrease) in creditors Net cash used in operating activities	(155,038) 6,248 (396,766) (334,963) (20,698) 274,349	(1,631,354) 9,033 1,164,506 (325,168) 12,973 (90,072)
	**(626,868) **	(860,082)

B Analysis of cash and cash equivalents

Analysis of cash and cash equivalents
	2023 £	2022 £
Cash at bank and in hand Cash held by investment managers Total cash and cash equivalents	596,126 54,278	340,724 335,961
	650,404	676,685

No separate reconciliation of net debt has been prepared as there is no difference between the net cash (debt) of the charity and the above cash and cash equivalents.

36 QNI Annual Report and Accounts Year to 31 December 2023

Principal accounting policies Year to 31 December 2023

The principal accounting policies adopted, judgements and key sources of estimation uncertainty in the preparation of the accounts are laid out below.

Basis of accounting

These accounts have been prepared for the year to 31 December 2023 with comparative information given in respect to the year ended 31 December 2022.

The accounts have been prepared under the historical cost convention with items initially recognised at cost or transaction value unless otherwise stated in the relevant accounting policies below or the notes to the accounts.

The accounts have been prepared in accordance with Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (Charities FRS 102 SORP 2015), the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) and the Charities Act 2011.

The charity constitutes a public benefit entity as defined by FRS 102.

The accounts are presented in sterling and are rounded to the nearest pound.

Critical accounting estimates and areas of judgement

Preparation of the accounts requires the members of Council and management to make significant judgements and estimates.

The items in the accounts where these judgements and estimates have been made include:

• assessing the probability of receiving legacies where the charity has been notified of its entitlement;

• estimating the useful economic life of tangible fixed assets for the purpose of determining the annual depreciation charge;

• determining the basis for allocating support costs across expenditure classifications;

• determining whether the heritage asset may be impaired; and

• estimating future income and expenditure flows for the purpose of assessing going concern (see below).

Assessment of going concern

The members of Council have assessed whether the use of the going concern assumption is appropriate in preparing these accounts. The members of Council have made this assessment in respect to a period of at least one year from the date of approval of these accounts. The members of Council consider that the uncertainty within the global geo-political context will impact on the economy in the year ahead.

UK inflation was high in 2023 and more settled in 2024. However, given the availability of reserves, the members of Council have concluded that there are no material uncertainties related to events or conditions that may cast significant doubt on the ability of the charity to continue as a going concern. The members of Council are of the opinion that the charity will have sufficient resources to meet its liabilities as they fall due.

Income recognition

Income is recognised in the period in which the charity has entitlement to the income and the amount can be measured reliably and it is probable that the income will be received. Income is deferred only when the

QNI Annual Report and Accounts Year to 31 December 2023 37

Principal accounting policies Year to 31 December 2023

charity has to fulfil conditions before becoming entitled to it or where the donor or funder has specified that the income is to be expended in a future accounting period.

Income comprises donations, legacies, investment income, interest receivable and grants in respect to charitable activities.

Grants and donations from government and other agencies and charitable foundations are included as income from activities in furtherance of the charity’s objectives where these relate to a specific project or activity or take the form of a contract for services. Where the money is given in response to an appeal or with greater freedom of use, for example monies for core funding, then the income is classified as a donation.

Donations and grants in respect to charitable activities are recognised when the charity has confirmation of both the amount and settlement date. In the event of amounts pledged but not received, the amount is accrued for where the receipt is considered probable. In the event that a donation or grant is subject to conditions that require a level of performance before the charity is entitled to the funds, the income is deferred and not recognised until either those conditions are fully met, or the fulfilment of those conditions is wholly within the control of the charity and it is probable that those conditions will be fulfilled in the reporting period.

Legacies are included in the statement of financial activities when the charity is entitled to the legacy, the executors have established that there are sufficient surplus assets in the estate to pay the legacy, and any conditions attached to the legacy are within the control of the charity.

Entitlement is taken as the earlier of the date on which either: the charity is aware that probate has been granted, the estate has been finalised and notification has been made by the executor to the charity that a distribution will be made, or when a distribution is received from the estate. Receipt of a legacy, in whole or in part, is only considered probable when the amount can be measured reliably and the charity has been notified of the executor’s intention to make a distribution.

Where legacies have been notified to the charity, or the charity is aware of the granting of probate, but the criteria for income recognition have not been met, then the legacy is treated as a contingent asset and disclosed if material. In the event that the gift is in the form of an asset other than cash or a financial asset traded on a recognised stock exchange, recognition is subject to the value of the gift being reliably measurable with a degree of reasonable accuracy and the title of the asset having being transferred to the charity.

Investment income is recognised once the dividend or interest has been declared and notification has been

received of the amount due.

Interest on funds held on deposit is included when receivable and the amount can be measured reliably by the charity; this is normally upon notification of the interest paid of payable by the bank.

Expenditure recognition

Liabilities are recognised as expenditure as soon as there is a legal or constructive obligation committing the charity to make a payment to a third party, it is probable that a transfer of economic benefits will be required in settlement and the amount of the obligation can be measured reliably.

All expenditure is accounted for on an accruals basis. Expenditure comprises direct costs and support costs. All expenses, including support costs, are allocated or apportioned to the applicable expenditure headings. The classification between activities is as follows:

• Expenditure on raising funds include the salaries, direct costs and support costs associated with generating donated income, together with the fees paid to investment managers in connection with the management of the charity’s listed investments; and

• Expenditure on charitable activities includes all costs associated with furthering the charitable purposes of the charity through the provision of its charitable activities. Such costs include charitable grants and donations, direct and support costs including governance costs.

38 QNI Annual Report and Accounts Year to 31 December 2023

Principal accounting policies Year to 31 December 2023

Welfare grants are made where the members of Council consider there is real need following a review of the details of each particular case and comprise single year payments rather than multi-year grants. Welfare grants are included in the statement of financial activities when approved for payment. Provision is made for grants and donations approved but unpaid at the period end where relevant.

Grants of award funding to institutions are included in full in the statement of financial activities when the award agreement has been returned, completed and signed, by the recipient. Small final instalments of some award grant payments are subject to receipt of a satisfactory final report on the award project.

Allocation of support and governance costs

Support costs represent indirect charitable expenditure. In order to carry out the primary purposes of the charity it is necessary to provide support in the form of personnel development, financial procedures, provision of office services and equipment and a suitable working environment. Governance costs comprise the costs involving the public accountability of the charity (including audit costs) and costs in respect to its compliance with regulation and good practice.

Support costs and governance costs are apportioned using percentages based on the time spent on the relevant activities by the employees of the charity.

Tangible fixed assets

All assets costing more than £500 and with an expected useful life exceeding one year are capitalised.

Expenditure on the purchase and replacement of furniture and equipment is capitalised and depreciated on a straight-line basis over the following periods:

• Leasehold improvements: 4 years

• • General office equipment, fixtures, fittings and furniture: 4 years • Computer equipment: 3 years

Heritage assets

During 2018, QNI discovered a piece of original artwork by Florence Nightingale, which had been given to it many years ago. Following further investigation, the value of the artwork was determined and is recognised in these accounts as a heritage asset. The asset was initially recognised on the balance sheet based on its estimated market value as at 31 December 2018 as determined by The Bowman Gallery, a specialist art valuer. This has been taken to be equal to its deemed cost for accounting purposes. No depreciation is charged against the asset, but the asset is reviewed annually for impairment.

Investments

Listed investments are a form of basic financial instrument and are initially recognised at their transaction value and subsequently measured at their fair value as at the balance sheet date using the closing quoted market price. Realised and unrealised gains (or losses) are credited (or debited) to the statement of financial activities in the year in which they arise.

The charity does not acquire put options, derivatives or other complex financial instruments.

As noted above, the main form of financial risk faced by the charity is that of volatility in equity markets and investment markets due to wider economic conditions, the attitude of investors to investment risk, and changes in sentiment concerning equities and within particular sectors or sub sectors.

Realised gains (or losses) on investment assets are calculated as the difference between disposal proceeds and their opening carrying value or their purchase value is acquired subsequent to the first day of the financial year. Unrealised gains and losses are calculated as the difference between the fair value at the

QNI Annual Report and Accounts Year to 31 December 2023 39

Principal accounting policies Year to 31 December 2023

year-end and their carrying value at that date. Realised and unrealised investment gains (or losses) are combined in the statement of financial activities and are credited (or debited) in the year in which they arise.

Debtors

Debtors are recognised at their settlement amount, less any provision for non-recoverability. Prepayments are valued at the amount prepaid. Debtors have been discounted to the present value of the future cash receipt where such discounting is material.

Cash at bank and in hand

Cash at bank and in hand represents such accounts and instruments that are available on demand or have a maturity of less than three months from the date of acquisition. Deposits for more than three months but less than one year have been disclosed as short-term deposits. Cash placed on deposit for more than one year is disclosed as a fixed asset investment.

Creditors and provisions

Creditors and provisions are recognised when there is an obligation at the balance sheet date as a result of a past event, it is probable that a transfer of economic benefit will be required in settlement, and the amount of the settlement can be estimated reliably. Creditors and provisions are recognised at the amount the charity anticipates it will pay to settle the debt. They have been discounted to the present value of the future cash payment where such discounting is material.

Fund structure

The general fund comprises those monies, which may be used towards meeting the charitable objectives of the QNI at the discretion of the Council.

The tangible and heritage assets fund represents the aggregate net book value of tangible and heritage assets at the balance sheet date. The value of such assets has been reflected on the balance sheet as a separate fund in order to emphasise the fact that the value of such assets should not be regarded as available to meet day-to-day expenditure. The assets are held for functional purposes in the case of tangible fixed assets or are retained as part of the charity’s archives in the case of heritage assets.

The designated funds are monies set aside out of the general fund and designated for specific purposes by the

Council.

The restricted income funds are monies raised for, and their use restricted to, a specific purpose, or donations subject to donor-imposed conditions. In the case of restricted income funds for welfare purposes, transfers are made to the general fund to reflect an agreed quarterly charging structure for staff time and office services attributable to providing welfare support from those funds.

The expendable endowment funds represent amounts held as capital until such time as members of Council decide to expend them subject to self-imposed conditions. Whilst held as capital, the funds generate income which is regarded as unrestricted.

Pension costs

Contributions in respect of the charity’s defined contribution pension schemes are charged to the statement of financial activities when they are payable to the relevant scheme. The charity’s contributions are restricted to the contributions disclosed in note 9. There were no outstanding contributions at the year end. The charity has no liability beyond making its contributions and paying across the deductions for the employees’ contributions.

Leased assets

Rentals applicable to operating leases where substantially all of the benefits and risks of ownership remain with the lessor are charged to the statement of financial activities on a straight-line basis over the lease term.

40 QNI Annual Report and Accounts Year to 31 December 2023

Notes to the accounts Year to 31 December 2023

1 Donations and legacies

	Unrestricted funds £	Restricted funds £ Endowment funds £ 2023 Total funds £ — — 305,000 25,707 — 35,968 — — 131,217 25,707 — 472,185 Restricted funds £ Endowment funds £ 2022 Total funds £ — — 300,000 — — 42,523 — — 342,523	Restricted funds £ Endowment funds £ 2023 Total funds £ — — 305,000 25,707 — 35,968 — — 131,217 25,707 — 472,185 Restricted funds £ Endowment funds £ 2022 Total funds £ — — 300,000 — — 42,523 — — 342,523
			300,000 42,523
	342,523		342,523

2 Investment income and interest receivable

2 Investment income and interest recei	vable
	Unrestricted funds £ Restricted funds £ Endowment funds £ 2023 Total funds £
Income from investments listed on a recognised stock exchange within the UK Bank and deposit interest	297,940 34,917 — 332,857 2,063 43 — 2,106
2023 total funds	300,003 34,960 — 334,963
	Unrestricted funds £ Restricted funds £ Endowment funds £ 2022 Total funds £
Income from investments listed on a recognised stock exchange within the UK Bank and deposit interest	290,633 32,732 — 323,365 1,780 23 — 1,803
2022 total funds	292,413 32,755 — 325,168

QNI Annual Report and Accounts Year to 31 December 2023 41

Notes to the accounts Year to 31 December 2023

3. Income from charitable activities

3. Income from charitable activities
				2023
	Unrestricted	Restricted	Endowment	Total
	funds	funds	funds	funds
	£	£	£	£
Improving nursing care in the
community
Innovation Programme (Elsie Wagg)	—	30,000	—	30,000
Burdett – Diabetes Innovation	—	38,326	—	38,326
IPC Champions Network	—	26,750	—	26,750
Care Home Nurse Network	—	9,000	—	9,000
Care Homes Network – RCN	—	18,000	—	18,000
NGS – Support for QN Leadership
programme	70,000	—	—	70,000
NGS – Support for Innovation programme	25,000	—	—	25,000
NGS – Support for QN Networks	—	25,000	—	25,000
AHP Development Programme	42,562	—	—	42,562
Bournemouth University	44,607	—	—	44,607
CNEN Sponsorship	25,000	—	—	25,000
Aspiring Leaders programme	82,998	—	—	82,998
ICB Chief Nurse Network Sponsorship	20,000	—	—	20,000
Field Specific Standard for Adult Social
Care Nursing	20,000	—	—	20,000
GPN Evaluation	10,000	—	—	10,000
Community Mental Health Nursing	—	9,999	—	9,999
Homeless and Inclusion Health programme	—	15,000	—	15,000
Community Nursing Research Forum	—	16,908	—	16,908
Community Nursing Executive Network
Company of Nurses	—	15,000	—	15,000
Annual QNI Conference	10,000	—	—	10,000
Sales of Resources	11,310	—	—	11,310
Fees, publications and sundry service	10,823	—	—	10,823
2023 total funds	372,300	203,983	—	576,283

42 QNI Annual Report and Accounts Year to 31 December 2023

Notes to the accounts Year to 31 December 2023

3 Income from charitable activities (continued)

	Unrestricted funds £	Restricted funds £	Endowment funds £	2022 Total funds £
		25,000 12,000 70,000 61,000 20,000 30,000 49,998 5,000 — 4,000 6,800 126,000 43,575 55,000 25,000 9,999 6,500 9,999 39,999 10,000 5,200 20,000 5,000 — — —	— — — — — — — — — — — — — — — — — — — — — — — — — —	25,000 12,000 70,000 61,000 20,000 30,000 49,998 5,000 40,282 4,000 6,800 126,000 43,575 55,000 25,000 9,999 6,500 9,999 39,999 10,000 5,200 20,000 5,000 19,000 1,208 956
	61,446	640,070	—	701,516

QNI Annual Report and Accounts Year to 31 December 2023 43

Notes to the accounts Year to 31 December 2023

4. Expenditure on raising funds

(a) Cost of generating grants and donations

Costs were incurred primarily in researching and developing relationships with grant making trusts.

	Unrestricted funds £ Restricted funds £ Endowment funds £ 2023 Total funds ~~£~~ 24,353 — — 24,353 5,629 — — 5,629 29,982 — — 29,982 Unrestricted funds £ Restricted funds £ Endowment funds £ 2022 Total funds 1,586 — — 1,586 71,234 — — 71,234 72,820 — — 72,820	Unrestricted funds £ Restricted funds £ Endowment funds £ 2023 Total funds ~~£~~ 24,353 — — 24,353 5,629 — — 5,629 29,982 — — 29,982 Unrestricted funds £ Restricted funds £ Endowment funds £ 2022 Total funds 1,586 — — 1,586 71,234 — — 71,234 72,820 — — 72,820	Unrestricted funds £ Restricted funds £ Endowment funds £ 2023 Total funds ~~£~~ 24,353 — — 24,353 5,629 — — 5,629 29,982 — — 29,982 Unrestricted funds £ Restricted funds £ Endowment funds £ 2022 Total funds 1,586 — — 1,586 71,234 — — 71,234 72,820 — — 72,820	Unrestricted funds £ Restricted funds £ Endowment funds £ 2023 Total funds ~~£~~ 24,353 — — 24,353 5,629 — — 5,629 29,982 — — 29,982 Unrestricted funds £ Restricted funds £ Endowment funds £ 2022 Total funds 1,586 — — 1,586 71,234 — — 71,234 72,820 — — 72,820
Direct costs Support costs (note 7) 2023 total funds				~~£~~ 24,353 5,629
	29,982	—	—	29,982
Direct costs Support costs (note 7) 2022 total funds				1,586 71,234
	72,820	—	—	72,820

(b) Management of investments

(b)Management of investments
	Unrestricted funds £ 48,770	Restricted funds £ Endowment funds £ 2023 Total funds £ 3,845 — 52,615 Restricted funds £ Endowment funds £ 2022 Total funds £ 5,611 — 53,017
2023 total funds
	Unrestricted funds £ 47,406
2022 total funds

44 QNI Annual Report and Accounts Year to 31 December 2023

Notes to the accounts Year to 31 December 2023

5 Expenditure on charitable activities

	Direct costs £	Grant funding of activities (note 6) £ Support costs (note 7) £ — 54,913 — 40,699 52,328 69,068 — 36,134 4,300 292,390 116,627 92,296 173,255 585,500	Grant funding of activities (note 6) £ Support costs (note 7) £ — 54,913 — 40,699 52,328 69,068 — 36,134 4,300 292,390 116,627 92,296 173,255 585,500	2023 Total funds £
		— — 52,328 — 4,300 116,627	54,913 40,699 69,068 36,134 292,390 92,296	173,755 128,780 218,544 114,335 925,179 292,045
	1,093,883	173,255	585,500	1,852,638

	Direct costs £	Grant funding of activities (note 6) £	Support costs (note 7) £	2022 Total funds £
		— — — 37,660 103,865 18,061 — —	15,874 22,717 87,355 61,217 35,936 3,325 3,945 36,379	102,106 146,127 561,901 393,775 218,271 24,711 29,324 234,003
	1,283,884	159,586	266,748	1,710,218

Management have elected to present the expenditure in line with the charity’s strategic charitable goals this year. This does create a discrepancy with the comparative year, however, it is not considered to detract from the understandability of the financial statements.

QNI Annual Report and Accounts Year to 31 December 2023 45

Notes to the accounts Year to 31 December 2023

6. Grant making

Innovation – grants payable to institutions

Innovation – grants payable to institutions
Fund for innovation	2023 £	2022 £
Total value Number ofgrants made	52,328	37,660
	40	16

These grants were awarded to support innovative community nursing projects or research and development projects conducted by named nurses. They were given in conjunction with professional development programmes delivered by the QNI.

Providing welfare support – grants made directly to individuals

	2023 £	2022 £
Total value Number ofgrants made	110,220	103,865
	360	392

Providing educational support – grants made directly to individuals

	2023 £	2022 £
Total value Number ofgrants made	6,407	18,061
	8	23

Grant commitments

As at 31 December 2023, the charity had annual welfare grant commitments of £23,900 (2022 – £22,867).

7. Support costs

Support costs are allocated to each area of charitable activity in proportion to the direct expenditure on those areas.

those areas.
	2023 £	2022 £
Policy Influence and Development Data and Evidence Innovation and Quality Improvement Standards Role models and Leaders Support for Nurses Organisation costs Council approved	54,913 40,699 69,068 36,134 292,390 92,296 5,629 —	15,874 — 61,217 22,717 87,355 43,206 71,234 36,379
	591,129	337,982

46 QNI Annual Report and Accounts Year to 31 December 2023

Notes to the accounts Year to 31 December 2023

8. Net expenditure and net movement in funds

This is stated after charging:

8. Net expenditure and net movement in funds This is stated after charging:
	2023 £	2022 £
Staff costs (note 9) Depreciation Operating lease rentals – land and buildings Amounts payable to the auditor in respect of: . External audit – current year . External audit –prioryear underprovision	1,073,483 6,248 56,966 17,400 3,679	937,734 9,033 55,666 8,871 2,518

9. Staff costs and remuneration of key management personnel

Staff costs during the year were as follows:

Staff costs during the year were as follows:
	2023 £	2022 £
Gross wages and salaries Employer’s national insurance contributions Employer’s pension costs Redundancy	891,680 91,523 80,280	781,906 83,157 72,671
	1,063,483 10,000	937,734 —
	1,073,483	937,734

One member of staff received emoluments (including taxable benefits but excluding employer’s national insurance and pension contributions) in the range of £100,001 - £110,000 (2022 – one in the range of £90,001 - £100,000). Contributions in the year to defined contribution pension schemes in respect of this employee totalled £10,480 (2022 – £9,980).

The average headcount of employees in 2023 was 21 (2022 – 19).

The average number of full-time equivalent employees in 2023 was 18 (2022 – 19).

The key management personnel of the charity in charge of directing and controlling, running and operating the charity on a day-to-day basis comprise the members of Council together with the Chief Executive, Chief Operating Officer (until June 2023), Head of Communications, Head of Finance, Director of Nursing Programmes (Innovation & Policy) and Director of Nursing Programmes (Leadership & Standards), The total remuneration payable to key management personnel during the year was £487,051 (2022 – £318,740).

10. Council members

No member of the Council received any remuneration in respect of their services as a member of the Council during the year (2022 – none). There was one Council member who had expenses reimbursed during the year in respect of travel totalling £4,093 (2022 – £715) which reflects the reinstatement of face-to-face meetings and the cost of travel in July 2023, to the International Council of Nurses member meeting and conference in Montreal. During the year members of the Council donated a total of £25,302 to the charity (2022 – £1,150).

11. Related party and connected person transactions

During the year £1,200 (2022 – £nil) was paid to a member of the council to deliver two sessions to the Aspiring Nurse Leaders Programme. Other than the aforementioned and the transactions reports within note 10 to the accounts, there were no other transactions with related parties or connected persons during the year (2022 – none).

12. Taxation

The Queen’s Nursing Institute is a registered charity and, therefore, is not liable to income tax or capital gains tax on income derived from its charitable activities, as it falls within the various exemptions available to registered charities.

QNI Annual Report and Accounts Year to 31 December 2023 47

Notes to the accounts Year to 31 December 2023

13. Tangible fixed assets

		Fixtures,
	Leasehold	fittings,
	improvemen	furniture and
	ts	equipment	Total
	£	£	£
Cost or valuation
At 1 January 2023	50,931	89,577	140,508
Additions	—	4,892	4,892
Disposals	—	(48,229)	(48,229)
At 31 December 2023	50,931	46,240	97,171
Depreciation
At 1 January 2023	50,931	75,092	126,023
Charge for the year	—	6,248	6,248
Disposals	—	(48,229)	(48,229)
At 31 December 2023	50,931	33,111	84,042
Net book values
At 31 December 2023	—	13,129	13,129
At 31 December 2022	—	14,485	14,485

14. Heritage assets

At deemed cost	£
At 1 January2023 and at 31 December 2023	70,000

During 2018, QNI discovered a piece of original artwork by Florence Nightingale, which had been given to it many years ago. Following further investigation, the value of the artwork was determined and is recognised in these accounts as a heritage asset. The asset was initially recognised on the balance sheet based on its estimated market value of £70,000 as at 31 December 2018 as determined by The Bowman Gallery, a specialist art valuer. This has been taken to be equal to its deemed cost for accounting purposes. No depreciation is charged against the asset, but the asset is reviewed annually for impairment. There have been no indications of impairment as at 31 December 2023 (and since the initial recognition of the asset).

15. Investments

15. Investments
	2023 £	2022 £
Investments listed on a recognised stock exchange Market value at 1 January 2023 Add: Additions at cost Less: Disposals proceeds Total investment gains (losses) Market value at 31 December 2023 Cash and settlements pending, held as part of the investment portfolio Total investments held Listed investments at cost	10,849,165 1,506,174 (1,776,690) 396,766	11,828,770 1,482,650 (1,297,751) (1,164,504)
	10,975,415 54,278	10,849,165 335,961
	11,029,693	11,185,126
	8,225,997	8,442,498

48 QNI Annual Report and Accounts Year to 31 December 2023

Notes to the accounts Year to 31 December 2023

15 Investments (continued)

At 31 December 2023, the listed investments comprised the following:

	2023 £ 1,597,585 3,971,912 3,926,024 1,479,894 10,975,415	2022 £ 1,321,133 4,347,069 3,355,396 1,825,567 10,849,165
Fixed interest UK equities Overseas equities Alternatives

At 31 December 2023, no holdings were material in the context of the entire portfolio value (2022 – none).

16 Debtors

16 Debtors
	2023 £	2022 £
Trade debtors Prepayments Accrued income Other debtors	37,680 15,047 37,000 3,984	46,427 11,040 11,000 4,546
	93,711	73,013

17 Creditors: Amounts falling due within one year

17 Creditors: Amounts falling due within one year
	2023 £	2022 £
Expense creditors Accruals Other creditors Deferred income (see below)	76,047 80,587 25,555 503,498	26,318 35,020 — 350,000
	685,687	411,338
Deferred income Balance brought forward Released in year Deferred in year Balance carried forward	350,000 (350,000) 503,498	438,575 (438,575) 350,000
	503,498	350,000

Deferred income consists of project funding received by the year end but which relates specifically to project work to be performed in future accounting periods.

18 Tangible and heritage assets fund

	2023 £ 2022 £
At 1 January 2023 Other movements in year	84,485 86,955 (1,356) (2,470)
At 31 December 2023	83,129 84,485

QNI Annual Report and Accounts Year to 31 December 2023 49

Notes to the accounts Year to 31 December 2023

18 Tangible and heritage assets fund (continued)

The tangible and heritage assets fund represents the aggregate net book value of tangible and heritage assets at the balance sheet date. The value of such assets has been reflected on the balance sheet as a separate fund in order to emphasise the fact that the value of such assets should not be regarded as available to meet day-to-day expenditure. The assets are held for functional purposes in the case of tangible fixed assets or are retained as part of the charity’s archives in the case of heritage assets.

19 Designated funds

The funds of the charity include the following designated fund which has been set aside out of unrestricted funds by the members of the Council for specific purposes.

	At 1 January 2023 £	New designation £	Utilised £	At 31 December 2023 £
Leadership and Innovation fund Phillip Goodeve-Docker fund Heyes legacy fund International Community Nursing Observatory The Welfare Legacies Fund	— 57,485 29,675 — —	241,000 100 — 390,000 47,458	(50,428) (2,500) — (56,182) (47,458)	190,572 55,085 29,675 333,818 —
	87,160	678,558	(156,568)	609,150
	At 1 January 2022 £	New designation £	Utilised £	At 31 December 2022 £
Leadership and Innovation fund Phillip Goodeve-Docker fund Heyes legacy fund	250,000 60,485 29,675	— — —	(250,000) (3,000) —	— 57,485 29,675
	340,160	—	(253,000)	87,160

The Leadership and Innovation fund represents funds set aside by Council to increase the team. This will strengthen the offer of leadership and innovation programmes and assist in the delivery of newly commissioned work.

The Phillip Goodeve-Docker fund represents monies given as ‘donations in memory’ which the Council has set aside in the memory of Phillip Goodeve-Docker who sadly passed away in 2013 during a fundraising trek across Greenland. The amount of funding raised, and on occasion added to be sponsorship activities of family and friends, means that under the current criteria for the award of the prizes, this fund will last in perpetuity.

The Heyes legacy fund comprises a legacy received during 2018 which has been designated towards enabling an increase in the number of funded places made available for the annual Queen’s Nurse Conference. At the time, it was considered that the fund would last approximately 5 years. However, the cost of the annual Queen’s Nurse meetings has been significantly reduced as they have been held remotely since 2021.

50 QNI Annual Report and Accounts Year to 31 December 2023

Notes to the accounts Year to 31 December 2023

The International Community Nursing Observatory fund was set aside by Council to establish the observatory. The goal of which is to collate, gather and analyse evidence based data on the nursing workforce.

In the year, the Council elected to designate most legacies received to support our welfare grant giving activity, supporting nurses in financial difficulty.

20. Restricted funds

	At 1 January 2023 £ Income £ Expenditure £ Gains, losses and transfers £ At 31 December 2023 £
District Nurses 1965 Fund TalkToUs Service Burdett – Diabetes Innovation Projects Company of Nurses Welfare Grants William Rathbone Annual Award Dora Roylance Fund Care Home Nurse Network Long–COVID - Community of Practice Aspiring Leaders programme Internationally Educated Nurses Innovation Programme (Elsie Wagg) IPC Champions Network NGS - Support for QN Networks Homeless and Inclusion Health Programme Community Nursing Research Forum Other Restricted Funds	632,726 34,960 (126,095) 29,858 571,449 55,588 — (10,928) — 44,660 — 38,326 (1,985) — 36,341 — 15,000 (10,750) — 4,250 — 20,311 (500) — 19,811 13,863 — (1,600) — 12,263 1,730 18,000 (19,730) — — 12,164 — (12,164) — — 54,936 — (54,936) — — 45,113 — (45,113) — — 8,613 30,000 (23,493) — 15,120 534 26,750 (27,284) — — — 25,000 (19,551) — 5,449 — 15,000 (6,323) — 8,677 457 16,908 (17,365) — — 32,612 24,395 (52,719) — 4,288
	858,336 264,650 (430,536) 29,858 722,308

QNI Annual Report and Accounts Year to 31 December 2023 51

Notes to the accounts Year to 31 December 2023

20. Restricted funds (continued)

District Nurses 1965 Fund (Welfare Fund)

This fund is a separate charitable trust administered by the Queen’s Nursing Institute and is known internally as the Welfare Fund. The fund must be used specifically for making grants to nurses who are, or who have been, associated with district and community nursing services and who are in financial hardship. As local District Nursing Associations in England closed over the years, additional funds have been transferred from the Associations to the 1965 Fund, with a specification that the funds should be used to support education grants for community nurses as well grants for those in financial hardship.

TalkToUs Service

The Covid19 Healthcare Support Appeal (CHSA) awarded a grant to the QNI in 2022 to enable the continued delivery of the TalkToUs service.

Dora Roylance Fund

The QNI received a legacy of £21,792 from a retired QN who died in 2015. The specification was that it was to be used for the support of Health Visitor education. A Dora Roylance Memorial Award has been created for the most outstanding achievement for every student Health Visitor in every university offering the Health Visitor programme in England, Wales and Northern Ireland. Taking into consideration the number of universities offering the Health Visitor programme and the total of the fund, the award is likely to last approximately 15 years to 2030.

Care Home Nurse Network

The QNI was funded by the RCN Foundation to support the ongoing development and associated activities of the Care Home Nurse Network for three years, commencing January 2020 to January 2023.

Long–COVID - Community of Practice

In 2021, NHSE/I seed funded the QNI to create a Community of Practice for nurses supporting people with Long Covid in the Community. Additional funding was received in 2022, enabled the network activity to continue, including the revision of the QNI Long Covid learning resource, published in October 2022.

Aspiring Leaders Programme

The successful Aspiring Leaders programme is now an open programme for all community nurses to be able to apply for the place through grant funding from employers, NHSE and the Company of Nurses.

International Recruitment support

The QNI was funded by NHSE to develop a film featuring a number of Internationally Educated Nurses working in a range of community settings and roles.

Innovation Programme (places)

Employers have an opportunity to purchase individual places for their employees on the innovation programme.

IPC Champions Network

DHSC provided funding to develop and deliver and Infection Prevention and Control (IPC) Champions Network in 2022 and 2023.

Community Nursing Research Forum

NHSE England funded the development of the Community Nursing Research Forum for delivery in 2022 and 2023.

National Garden Scheme Networks

The National Garden Scheme committed funding to support four networks of the QNI when funding became unexpectedly unavailable. These include the Long Covid Nurse Group, the Community Children’s Nurse Network, the General Practice Nurse Network and the Homeless and Inclusion Health Network.

52 QNI Annual Report and Accounts Year to 31 December 2023

Notes to the accounts Year to 31 December 2023

Burdett – Innovation projects

The Burdett Trust for Nursing funded seven projects focussed on nurse-led innovations in caring for people with diabetes.

Community Nursing Research Forum

The Forum was funded by NHSE in 2022/23 in support of the delivery of the NHSE Community Nursing Plan.

Company of Nurses – financial assistance grants

The QNI administers grants for financial assistance on behalf of the Company of Nurses.

Homeless & Inclusion Health - DHSC

The Department of Health and Social Care (DHSC) provided a grant to support the development of field specific standards in Inclusion Health and the promotion of the use of the standards in universities offering the NMC regulated Community Nursing Specialist Practice Qualification.

William Rathbone X annual award

Lucy and Nick Addyman sponsor the annual William Rathbone X Award for the most outstanding executive nurse of a community services provider.

Whilst the expendable endowment fund is ordinarily intended to be held as longer-term capital, investment income generated by the underlying investments is unrestricted based on the terms of the expendable endowment. Accordingly, the investment income is credited to the charity’s unrestricted general funds, and any expenditure intended by Council to be met from the charity’s expendable endowment is thus allocated against the charity’s unrestricted general funds in the first instance.

21. Expendable endowment fund

The fund was established originally following the disposal of the QNI’s freehold property in Belgravia, London. Movements on the endowment fund during the year to 31 December 2023 are as shown below:

	2023 £	2022 £
Fund value at 1 January Net investment (losses) gains Transfer to unrestricted general funds (see below) Fund value at 31 December

The capital (including any cumulative unrealised gains) may be expended by the charity at the discretion of Council in accordance with self-imposed conditions consistent with the achievement of the charity’s overall strategic plan. Council’s general approach and policy is to keep the underlying capital preserved as far as possible, and to only convert the endowment fund into income funds where, for example, the investment income generated by the endowment alone is insufficient to cover the cost of strategic initiatives which is intended to be met from the endowment, or for example, where the charity requires a top-up of its general unrestricted funds in order to sustain an appropriate level of free reserves.

In light of the decrease in the charity’s unrestricted general funds, Council have elected that £631,000 of the endowment capital is converted into unrestricted income funds during the year ended 31 December 2023.

QNI Annual Report and Accounts Year to 31 December 2023 53

Notes to the accounts Year to 31 December 2023

22. Analysis of net assets between funds

	General funds £	Tangible and heritage assets fund £	Designated funds £	Restricted funds £	Endowment funds £	Total 2023 £
Fund balances at 31 December 2023 are represented by: Tangible fixed assets Investments Net current (liabilities) assets	— 751,981 (166,830)	83,129 — —	— 609,150 —	— 551,328 170,980	— 9,117,234 —	83,129 11,029,693 4,150
	585,151	83,129	609,150	722,308	9,117,234	11,116,972
	General funds £	Tangible and heritage assets fund £	Designated funds £	Restricted funds £	Endowment funds £	Total 2022 £
Fund balances at 31 December 2022 are represented by: Tangible fixed assets Investments Net current (liabilities) assets	— 1,169,399 (343,639)	84,485 — —	— — 87,160	— 599,458 258,878	— 9,416,269 —	84,485 11,185,126 2,399
	825,760	84,485	87,160	858,336	9,416,269	11,272,010

The total unrealised (losses) gains as at 31 December 2023 constitute movements on the revaluation of listed investments and are as follows:

	2023 £	2022 £
Cumulative unrealised gains within note 15 On listed investments Total unrealised gains at 31 December Reconciliation of movements in unrealised gains (losses) Unrealised gains at 1 January Less: in respect of disposals in the year Net gains arising on revaluation in the year Unrealisedgains at 31 December	2,749,418	2,406,665
	2,749,418	2,406,665
	2,406,665 (36,092) 378,845	4,078,295 (681,457) (990,173)
	2,749,418	2,406,665

23. Operating leases

At 31 December 2023 the charity had annual commitments under non-cancellable operating leases as follows:

	Land and	buildings
	2023 £	2022 £ 76,281 209,774 286,055
Due within: . One year . Two to five years	78,740 59,055
	137,795

54 QNI Annual Report and Accounts Year to 31 December 2023

Notes to the accounts Year t ~~o~~ 31 December 2022

1A Henrietta Place London W1G 0LZ

020 7549 1400

www.qni.org.uk

Patron HM The Queen Charity no: 213128 Founded 1887

QNI Annual Report and Accounts Year to 31 December 2023 55