Company Number: 01213983 Charity Number: 268396 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **ANNUAL REPORT AND UNAUDITED FINANCIAL STATEMENTS** 

**31 MAY 2022** 

RSM UK Tax and Accounting Limited Third Floor, One London Square, Cross Lanes, Guildford, Surrey GU1 1UN 



**Page 1** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

The trustees present their report and the financial statements of The British Society for Surgery of the Hand (also known as “BSSH” or “the Society”) for the year ended 31 May 2022. 

The financial statements have been prepared in accordance with the accounting policies set out in the notes to the financial statements and comply with the Charities Act 2011, the Companies Act 2006, the Memorandum and Articles of Association of the charitable company, 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 UK and Republic of Ireland (FRS 102) (effective 1 January 2019). 

## **OBJECTIVES AND ACTIVITIES** 

## **Charitable objectives** 

The charitable objective for which the charity is established is as follows: 

To promote and direct the development of hand surgery, to foster and co-ordinate education, study and research in hand surgery, by disseminating knowledge among members of the medical and allied health professions. 

## **Charitable activities** 

In pursuance of its charitable objectives, the Society’s principal activity is the dissemination of information as it relates to the specialty. 

Each year, this activity is undertaken in a number of ways by BSSH: 

- Leading and guiding professional practice and being responsive to the needs of constituent members of the Society; 

- Forming a governing body to formulate and implement policy and manage the affairs of the Society; 

- Undertaking specific hand surgery related projects through its committees; 

- Defining professional competency in terms of knowledge and skills; 

- Promoting undergraduate and postgraduate education and continuing professional development; 

- Advancing the science of hand surgery by stimulating and supporting research and disseminating knowledge at scientific meetings and through the Journal of Hand Surgery (European Volume); and 

- Being responsive to the needs and aspirations of patients and their representatives. 

The membership of the Society is composed mainly of consultant and trainee orthopaedic and plastic surgeons who have an interest in hand surgery. As part of their subscription to the Society, members receive the Journal of Hand Surgery, as well as details of current events such as hand surgery conferences and information on recent and relevant hand surgery issues. BSSH subscribes to the International Federation of Societies for Surgery of the Hand (IFSSH) and the Federation of European Societies for Surgery of the Hand (FESSH), thereby affiliating BSSH members to both these organisations. 

The Society normally organises two scientific meetings each year, to disseminate new medical information to members and others. The meetings consist of original papers, lectures, symposia and poster presentations. They play an important part in the training of hand surgeons and the continuing medical education of consultants. 

The Society also organises Instructional Courses in Hand Surgery comprising eight two-day courses, held over a four-year period. The series of courses covers the entire spectrum of surgery of the hand and wrist, making it the most comprehensive teaching in this field in Europe. 



**Page 2** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

The Journal of Hand Surgery (European Volume) is owned by the Society and published by SAGE. The Editor of the Journal’s role is to review and edit the papers submitted for publication with support and assistance provided by the Editorial Assistant and Editorial Board. The Committee of Management of the Journal provides supervision of the commercial production and marketing aspects of the Journal. 

The Education and Training in Hand Surgery Committee works to further the education and training agenda of the Society. Its remit includes the inception, development, promotion, and maintenance of activities relating to continuing professional development both of trainee and established surgeons. Educational, Travel and Student Elective bursaries and video prizes are awarded on the recommendation of this committee. The Committee also receives applications for the Stack Fellowship in memory of surgeon Graham Stack. The Fellowship is awarded to enable visits to hand surgery centres of excellence and interest both in the UK and internationally. 

The Research Committee advances and facilitates hand surgery research amongst the membership of the BSSH. The Committee reviews applications from members for an annual research fellowship as well as grants intended principally to pump prime early studies and systematic reviews that may lead to applications for larger funding from other organisations. 

The Communications Committee increases public, organisational and medical awareness of hand surgery and hand surgeons. It aims to optimise communication within the BSSH to increase connectivity, engagement and understanding amongst patients, surgeons, allied medical professionals and the general public. 

The Trauma Committee advances hand trauma care in the UK through producing standards of care for hand injuries, developing a hand injury prevention strategy, maintaining the hand injury triage app and developing clinical networks for hand trauma. 

The Audit and Hand Registry Committee advances and facilitates clinical audit for the membership of the BSSH, and provides audit capability by maintaining, updating and upgrading the BSSH UK Hand Registry and website. The Committee oversees the annual UK Hand Registry award which supports proposals for research projects that can utilise existing and future data collected through the UK Hand Registry. 

The Overseas and Overseas Trainee Committees develop and coordinate sustainable educational and surgical projects across the developing world and aim to deliver maximum possible benefit for patients in need of hand surgery in the developing world. The Trainee Committee specifically seeks to involve trainee surgeons in the overseas work of the BSSH. The Committee manages the BSSH Overseas Fellowship which facilitates trainee involvement in global hand surgery. 

The Society has, in partnership with the University of Manchester, developed the Postgraduate Diploma in Hand Surgery. This is a validated programme of study, and on successful completion the Diploma in Hand Surgery is awarded. The programme is a distributed learning system with 8 taught modules that include locally administered coursework assessments and a final examination. 

The Society has established an MSc in Hand Surgery. This one-year course is available to those candidates who have successfully completed the diploma course and who then choose to progress to a higher postgraduate qualification in Hand Surgery with the BSSH and in conjunction with the University of Manchester. 

The Society’s website is maintained professionally and updated by the Secretariat and Webmaster. The site provides information on all aspects of hand surgery for the members, medical professionals and the general public. 



**Page 3** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

## **Indicators, milestones and benchmarks** 

The trustees monitor a range of measures by which to try to determine the success of the charity in meeting its objectives. These measures include: 

- Level of membership as a percentage of total eligible consultants, and the trend over time (increasing or decreasing); 

- Levels of interest in trustee and committee roles; 

- Attendance at the bi-annual scientific meetings; 

- Feedback from delegates attending the scientific meetings, the uptake on new initiatives to encourage attendance, and feedback on individual sessions, papers, and lectures at the scientific meetings; 

- Numbers of papers submitted for the scientific meetings; 

- Circulation, readership and impact factor of the Journal of Hand Surgery; 

- Number of papers submitted for publication in the Journal; 

- Requests for publications including abstracts and papers; 

- Throughput of delegates taking the Instructional Courses in Hand Surgery; 

- Number of applicants for the Diploma in Hand surgery; 

- Levels of interest expressed in the range of grants offered by the Society; and 

- • Number of visits to the Society’s website and feedback from visitors. 

## **Public benefit** 

The trustees have taken The Charity Commission’s general guidance on public benefit (contained within the recent publication “Charities and Public Benefit”) into consideration in preparing their statements on public benefit contained within this trustees’ annual report. 

## _Benefits and beneficiaries_ 

In accordance with its charitable objectives, the Society strives to improve patient care and to improve the quality of medical and surgical care for the benefit of patients within the specialty of hand surgery. The charity’s ultimate beneficiaries are therefore patients, and benefits to patients are provided through continuing dissemination of information in relation to the specialty by the Society. 

## _Trustees’ assessment of public benefit_ 

In relation to the assessment of public benefit, the trustees believe that the contribution of BSSH to the education and training of hand surgeons in the UK directly improves patient care. The trustees aim to confirm this by direct interaction with the public. 

During the period in question, the trustees gathered the following evidence that demonstrates to their satisfaction that BSSH continues to benefit the public through its activities targeted to achieve its charitable objectives: 

- Continuing  and increased engagement with the membership through surveys; 

- Diversifying its educational offer to provide high quality educational events online as well as face to face; 

- Monitoring attendances at and interaction in the scientific meetings; 

- Numbers of individuals attending the Instructional Courses and the Diploma in Hand Surgery; 

- Surveying delegates who attend Scientific Meetings and Instructional Courses to comment on how their attendance at such meetings and courses will ultimately be of benefit to their patients; 

- Co-opting a lay person for a three-year period to attend Council meetings and thereby help to inform the trustees directly on public benefit. This is being furthered by an initiative appointing lay persons to all Committees. The Society is also considering options to further this initiative with the appointment of a new surgeon Public and Patient Initiative Lead; 



**Page 4** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

- The Society, through the work of its Education and Training Committee, has undertaken to improve the patient information available on its website, creating a working group to improve its accessibility and obtain the Patient Forum Association (PFA) gold standard accreditation; 

- Creating a scheme to offer training opportunities to allied health professionals in aspects of hand surgery, improving care for patients treated at primary care level; 

- Engaging with NHS England and the national Getting It Right First Time (GIRFT) programme to publish hand surgery pathways and guidance across the UK for Carpal Tunnel, Bite Wounds, Operating Outside of Main Operating Theatres and Digit Amputations. These guidelines will ultimately improve outcomes for patients; 

- Publishing standards of care in hand trauma management for Mallet injuries, Animal and Human Bite injuries, Metacarpal neck fractures and Flexor sheath infections; 

- Creating a series of press releases and campaigns to improve public awareness of common hand injuries; 

- • Taking part in the Quality Improvement Project “HandsFirst Collaborative” with the Royal College of Surgeons of England focussing on improving the quality of care for hand trauma patients. 

## **Grant making policy** 

The range of grants offered by the Society is developed and awarded on the recommendation of the relevant subcommittees. Where appropriate, application forms are provided, and the subcommittee assesses applications and applicants prior to making awards. Awards in excess of the current framework are given should the applications be deemed worthy in excess of the prescribed amounts. 

The following grants are advertised annually and are available by application and peer review allocation: 

- Education and Travel Bursary. These individual grants of £5,000, with total funding of £20,000 per annum, are for members who wish to travel to centres of hand surgery, nationally and internationally and can be used to cover travel and accommodation. 

- BSSH Educational Grants. An annual amount of £10,000 is available per year for any activity supporting education and training relating to the management of patients with hand pathology. 

- UK Hand Registry Award. An annual award of £2,000 to support proposals for research projects that can utilise existing and future data collected through the UK Hand Registry. 

- Medical Student Elective Bursary. The BSSH offers four annual bursaries of £1,000 to support medical student elective programmes in Hand Surgery. 

- Pulvertaft Essay Prize. The Society offers a prize of £1,500 for an essay on a topic decided by the President of that year. 

- Educational Video Presentation Prize. Two prizes to the value of £750 each are intended to encourage the production of videos on hand surgery to enlarge the BSSH audio-visual library. 

- The Stack Fellowship offers an honorarium of £12,000 to enable visits to centres of excellence and interest in the UK and elsewhere. 

- BSSH/Healing Foundation Medical Electives Awards. The Healing Foundation in conjunction with BSSH offers Medical Student Electives Awards of £1,200 for the personal support of students during their 6-8 week elective period. The BSSH contributes £1,800 towards three awards annually. 

- Research Grant/Fellowship. Maximum funds of £50,000 per year are available to fund clinical or basic science research of relevance to hand surgery. 

- Pump Priming Grant. Two grants of £10,000 each are available annually for projects intending to stimulate interest in further research with the potential to benefit patients. 

- The Society offers an annual budget of £32,000 to the Overseas Committee to facilitate fellowships and deliver a programme of visits. 

- A Poster Prize of £250 is awarded for the best poster at both the Autumn and Spring Meetings. 

- Two Hand Therapists are invited to attend each Instructional Course free of charge. 

- Two Royal College of Surgeons Surgical Specialty Lead roles are funded, one fully at £15,000 and the other split with the British Association of Plastic, Aesthetic and Reconstructive Surgeons (BAPRAS) for £7,500. 



**Page 5** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

- The Society nominates a Hand Training Interface Group Fellow for the American Society for Surgery of the Hand ‘s (ASSH) International Travelling Fellowship and awards a grant of £5,000. 

- The BSSH matches the study leave funding of up to £1000 for each hand TIG fellow to attend BSSH, FESSH or IFSSH organised meetings. 

- General Funding Applications. The BSSH general grant is available to members for any work that is in line with the charitable aims of BSSH but does not meet the criteria of the above grants. 

## **Relationships with connected entities** 

BSSH works closely with its parent surgical specialties; the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) and the British Orthopaedic Association (BOA). Close links are also maintained with the British Foundation for International Reconstructive Surgery and Training (BFIRST) for its overseas projects. 

The BSSH continues to build links with the British Association of Hand Therapists (BAHT) offering representative positions to BAHT members on each of its Committees and Council. 

The BSSH has also continued to build relationships and networks internationally being invited as the guest Society to both the American and Indian Hand Societies. 

## **Representation on other bodies** 

The Society is one of the founding members of the Scar Free Foundation and is represented on its Research Board. 

The Society liaises with other sub-specialties through the Royal College of Surgeons of England Interface Committee in Hand Surgery. This committee is Intercollegiate under the remit of the Joint Committees on Higher Surgical Training (JCST). The BSSH also has representation on the Hand Training Interface Group (TIG) Committee. 

In addition, and in pursuing its charitable objectives, the Society has representation on various other relevant external bodies, such as the Board of Specialist Societies of the British Orthopaedic Association and BAPRAS Council. 

The Society has a Representative Delegate on the Federation of European Societies for Surgery of the Hand (FESSH) and the International Federation of Societies for Surgery of the Hand (IFSSH). The post holder represents the BSSH at the delegate meetings of these societies. 

A Council member and two further BSSH members also serve as representatives on the FESSH Hand Trauma Committee. BSSH also has representatives on the examination board of the FESSH Diploma. 



**Page 6** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

**TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

## **ACHIEVEMENTS AND PERFORMANCE** 

## **Activities and events 1 June 2021 – 31 May 2022** 

## **Events** 

Due to the ongoing impact of the COVID-19 pandemic two planned face-to-face events were converted to online events during this period. 

Course three in series eight of the Instructional Course in Hand Surgery (ICHS) was held online on 4-5 June 2021. This event attracted one online sponsor. There were 125 paying participants to the event, 109 doctors and 16 therapists. The ICHS Organising Committee introduced a new initiative for delegates from lower and middle income countries (LMICs) to attend the course for free. This attracted 159 LMIC delegates. 

Course four in series eight was also held online on 4-5 February 2022. This event had three online sponsors. There were 93 paying participants, 89 doctors and 4 therapists. 63 LMIC delegates were able to attend the course for free. 

Attendance figures for the Instructional Course have remained stable. The trustees note that attendance at the Instructional Courses can vary considerably depending on the topic. 

The Autumn Scientific meeting was held at the Oxford Examinations Schools on 9-10 September 2021. 36 papers were presented at this meeting. 14 poster infographics were made available at the venue and online. The Harold Bolton lecture was delivered by Mr C Heras-Palou and The Douglas Lamb lecture was delivered by Mr D Sammut. The meeting included guest lectures Professor A Pusic, Dr E Sellon, Mr C Harrison, Mr N De Pennington, Professor T Vincent and Mr R Feitz. The BSSH Mentoring Scheme launched at this event providing space for matched mentors and mentees to meet. There were 305 participants, 166 consultant members, 66 associate members, 5 honorary members and 66 non-members. The delegate numbers for scientific meetings remain at the 250 - 300 mark. There were seventeen sponsors for this event. 

There was no Spring scientific meeting held in 2022 owing to the IFSSH Congress planned for June 2022 in London. 

## **Journal** 

The Society continues to publish the Journal of Hand Surgery (European Volume) and provides this journal to all its members.  Full members also receive the Journal of Hand Surgery (American volume). The circulation of the journal is stable. Subscribers now have access to the full archive of the journal going back to 1969, via SAGE online journals. For the period in question, 146 full length articles, 19 review articles and 68 short reports and letters were published from 655 submissions. The journal twitter account continues to promote important issues instantly. 

The impact factor for the journal during this period peaked at 2.688 and then reduced to 2.490 making it currently the second-highest rated hand surgery journal in the word. Journal sales have been relatively stable overall for the period 1 June 2021 – 31 May 2022. 



**Page 7** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

**TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

## **Hand Diploma and Masters Committee** 

The Postgraduate Diploma in Hand Surgery programme began in September 2006 and since then 277 candidates have enrolled on the programme. 20 candidates sat the exam in October 2021. 57 candidates have withdrawn from the programme or were removed as they exceeded the maximum allowable period of study. The programme continues to be taken up enthusiastically by many but not all of the Interface Hand Fellows nationally with 26 candidates enrolling in 21/22. There is a well refined bank of written questions and skill stations for the examinations. Much interest has been generated in other specialties who would like to benchmark the programme and there is further interest internationally. 

The masters programme has 7 students enrolled.  3 dissertations were due for submission in September 2022. 

The committee and examiners ran two exams in parallel in October 2021 due to an increased number of candidates, owing to the global pandemic. The venue was changed facilitate the running of two exams. As a contingency, in case of a peak in COVID numbers, BSSH subsidised candidates’ accommodation so the whole exam was located in one venue, minimising candidates’ potential exposure. 

## **The Education and Training in Hand Surgery Committee** 

The Committee continued to offer all bursaries and awards. Levels of awards have returned to near normal after the initial effects of the pandemic, with occasional necessary changes in plans supported where required and requested. 

The Society doubled the funds available for its Pulvertaft essay prize owing to the fact that fewer travel bursaries were awarded due to the ongoing uncertainty of travel due to the pandemic. 

The Education and Training committee granted two Education and Travel Bursaries, five Medical Student Elective Bursaries, one Educational Grant and three Pulvertaft Prizes in this period. 

Over the year, the Committee continued to grow the BSSH Mentoring Scheme providing free professional mentoring training for consultant hand surgeons. Links were then set up between the trained mentors and newly appointed BSSH surgeons who requested a mentor. It was agreed to open the scheme up to post-CCT and TIG hand fellows, plus early years consultants (within 5 years of appointment) to be more inclusive. 

The inaugural BSSH funded International Travelling Fellowship took place in September 2022. 3 fellows from Europe and 1 from the USA, nominated by their home Societies visited hand surgery centres of excellence in Manchester, Derby and Oxford. A joint report from showed that they found the experience “ inspiring, meant for showing the high standards of treatment in the United Kingdom” and that they went back to their respective countries “enriched with new ideas and many new friends.” 

2021 saw the work for the IFSSH Travelling Fellowship begin. Planning took place to invite 33 fellows from around the world to take part in an International Fellowship. The aim of the fellowship is to foster international links and friendships across the speciality and facilitate the sharing of education, research and best practice in Hand Surgery. 

The Committee continued to review and update the patient information leaflets available on the website increasing their accessibility and seeking the Patient Forum Association (PFA) gold standard accreditation for this. 

The Committee have also been continuing their research into developing a course for allied health professionals on aspects of hand surgery, this has started back into focus after the interruption due to the COVID-19 pandemic. 



**Page 8** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

## **Research Committee** 

The Research Committee has awarded two research grants in 2021/2022. Promoting research in Non-invasive electrical stimulation to augment peripheral nerve regeneration, Improving scaphoid fracture diagnosis using artificial intelligence (scAIphoid). 

Four awards were made for Pump Priming to support projects in PROximal interphalangeal Joint fracture dislocations, Epidemiology, Classification, Treatment (PRO-JECT), Develop and validate an AI algorithm to diagnose scaphoid fractures on radiographs, Identification and validation of tissue-resident human Skeletal Stem Cells (hSSC) in the 1st Carpo-metacarpal Joint (CMCJ) of osteoarthritic (OA) patients and How Diffusion changes within the Ulnar Nerve following Cubital Tunnel Release 

The Committee held a ‘Studyathon’ in September 2021 resulting in one research paper being accepted for publication in the Journal of Hand Surgery, American Volume. Two further papers are also in preparation. 

The committee has also been actively involved in the following: 

- The development of National Institute for Health and Care Excellence (NICE) guidelines on management of acute UCL injuries of the thumb 

- The development of NICE guidelines on management of thumb base OA 

- Developing a cohort study to investigate the management of PIPJ fracture dislocations in the UK 

- A systematic review of Non-surgical treatments for Dupuytrens 

- A service evaluation of treatment of SL and TFCC injuries 

- The development of a randomised control trial of different prep solutions in hand surgery. 

## **Trauma Committee** 

The Hand Trauma App, launched in April 2019, is maintained and developed by the Committee and was adapted in 2020 to provide guidelines for treating cases during the COVID-19 outbreak. The Committee also published four further BSSH Standards of Care in Hand Trauma in the following areas: Metacarpal Neck Fracture Management, Bite Management, Flexor Sheath Infection and Mallet Injuries. 

The committee gained Council approval to run a Quality Improvement Project “ HandsFirst Collaborative” with the Royal College of Surgeons of England f ocussing on improving the quality of care for hand trauma patients. The project has brought together teams from hospitals to seek improvements in outcomes for hand trauma patients by reducing variation and time to surgery for this patient group. In this time period the project was set up and the testing of ideas began. 

## **Audit and Hand Registry Committee** 

The BSSH Hand Registry website was launched in 2012. The Audit Committee continue to work towards including further improvements to the UK Hand Registry. In early 2022, ten instructional videos were created for use by UK Hand Registry users. The Audit database launched the first UK Hand Registry Award this year that supports research projects that will use the registry or its data. This year the award went to Flexor Tendon research. 

Currently, 1 in 4 of BSSH consultants use the UK hand registry to audit their surgical outcomes and the database currently holds patients’ scores for 13,682 procedures, expanding at a rate of 1.5% a month.  This continued to be affected by the rise in COVID-19 in early 2022. It is anticipated that if COVID-19 does not affect operating schedules in the future, then the procedures entered into the UK Hand Registry will increase. 



**Page 9** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

## **Patient and Public Initiative (PPI)** 

The Society’s PPI is fundamental to the development of the society and all its activities. As a charity that represents hand surgery care in the UK, patient care and public awareness of the care of the hand are integral to the society’s many activities. A new surgeon lead for the initiative was appointed in September 2021. The role of the PPI lead has been enhanced during this period by further involving the Council PPI representative in BSSH projects. 

## **Overseas Committee** 

In order to maintain a connection with overseas contacts and to continue providing educational resources to those in lower and middle-income countries (LMICs) during the global pandemic, the committee organised a series of webinars for LMIC delegates. Between 1 June 21 and 31 May 2022, the Committee delivered 10 webinars on topics including nerve injuries, wrist fractures and elbow and wrist dislocations  which have attracted a total of 2275 attendees from 92 countries. 

During 2021/2022, the BSSH Overseas Committee has: 

- Sponsored 20 LMIC delegates to attend the online Ganga virtual hand surgery course; 

- Set up fellowships to enable LMIC delegates to attend the 2022 IFSSH conference and visit UK hand surgery centres; 

- Arranged initial talks with colleagues in Malawi regarding the creation of a BSSH-supported hand surgery unit and agreed to fund £100,000 for its first year of operation. 

## **The Communications Committee** 

The Communications Committee has worked on the following projects during the period 1 June 2021 – 31 May 2022: 

- Hands Reworked book 

- Investigated the incorporation of Wide-awake Local Anesthesia No Tourniquet (WALANT) surgery educational resources into the BSSH website 

- Patient information update for website in collaboration with the Education committee 

- Appointed internal communications representative to focus on member-facing communications strategy 

- Expanded the BSSH presence on YouTube. 

The Society has active profiles across all main social media platforms including Twitter, LinkedIn, Facebook, YouTube and Instagram where users are kept up to date with regular content from the society and the specialty in general. The @BSSHand Twitter account now has almost 5,000 followers, with fantastic engagement from the membership and our Instagram account has 2,253 followers. Our LinkedIn page meanwhile has almost 600 followers, and our Facebook page has 213 likes and 242 followers, while our YouTube page has gained almost 1,000 subscribers. 

The Society continues to produce bi‐monthly member e‐bulletins with positive engagement from the membership. 

The work of the Communications Committee has led to an increase in the number of visits to the Society's website: From 1 June 2021 – 30 May 2022, the BSSH website was visited a total of 289,003 times (vs. 2020/2021: 207,144). This is an increase of 81,859. The majority of this audience are deemed to be members of the public, given that most traffic received is organic (i.e., searching on Google, not looking for us directly) and most are first‐time visitors landing on patient information pages. This confirms the importance of the ongoing update of patient information resources. 



**Page 10** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

## **Standalone projects** 

## **Cranfield Trust** 

Following the review by the Cranfield Trust into the BSSH’s Governance procedures and the subsequent report, the working party has worked with the trustees to implement the relevant proposals. Improvements have been made to officer election procedures, with the Honorary Secretary position now elected directly by the voting members of the BSSH. The trustees have also created a financial audit and risk committee to maintain a robust overview of the Society’s finances. 

## **Raising hand surgery standards project** 

Relationships have been developed with NHS England and the Getting It Right First Time initiative to develop and publish guidelines for operating outside of main operating theatres and best practice pathways for hand surgery. 

## **Equity Diversity and Inclusion (EDI)** 

The past financial year has seen an encouraging expansion of the Society’s EDI activities: 

- The EDI Lead was involved in Society’s Cranfield Trust Governance review including input into revision of the Constitution 

- An invitation sent to BSSH Members seeking interest to form an EDI network yielded 12 responses. Following this, plans were made to develop a Society EDI Network using MS Teams as platform for communication and collaboration 

- An EDI section has been in development on the BSSH website 

- An EDI session is planned within the programme for the Autumn Scientific meeting in 2022. The aim is to encourage greater membership involvement in discussion of the Society’s EDI strategy, the working draft of which can be found by clicking here. 

- EDI activities are now a standing item on the council meeting agenda and a routine part of the BSSH Annual Report. 

## **Hands Re:Worked** 

This project to ‘crowdfund’ a coffee table style book of photographs and inspirational stories from hand surgery patients showcasing the work of BSSH surgeons has progressed throughout 2021/22. Patient photographs and stories have been collected. An ISBN number has been obtained for the book and a draft publication date of October 2022 is anticipated. 

## **Review of Constitution** 

The Society undertook a large project to review its governing document in order to modernise it as it has last been reviewed in 2005. The working group included the PPI and EDI representatives.  The Society objects were reworded to put patients at the centre of its charitable aims and membership categories were reviewed to be more inclusive. This resulted in the widening of Consultant membership to SAS level doctors and the creation of two new categories: student and core and foundation. The changes regulated by the charity commission are currently undergoing approval. 

## **Update to Committee Terms of Reference** 

The Society completed a review of the committee terms of reference with a view to rationalise them where possible. Each committee now has an updated terms of reference with local variations where required. The terms of reference are available to all members on the BSSH website with the aim of making information on the more accessible to members. 

## **Student and Trainee Association for Surgery of the Hand (STASH)** 

Following the creation of the above two membership categories, the Society worked with medical students and trainees to set up STASH. This group will help to develop the BSSH offer to its new student, foundation and core members. 



**Page 11** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

## **Membership Levels** 

- Membership levels decreased slightly but remain largely consistent:  There were 858 Members (2020/2021: 921) of which 427 were Fellow Members (2020/2021: 424). It is thought the impact of the global economic crisis may have played a part in this small decrease. 


**----- Start of picture text -----**<br>
BSSH Membership<br>1000<br>900<br>800<br>700<br>600<br>500<br>400<br>300<br>200<br>100<br>0<br>05/31/2017 05/31/2018 05/31/2019 05/31/2020 05/31/2021 05/31/2022<br>Total Members Fellow Members<br># of Members<br>**----- End of picture text -----**<br>


The Society reviewed its election procedures for officers and obtained new software to run elections in an effort to increase the transparency of the process. The appointment process for committee chairs was also amended, with applicants now shortlisted and interviewed. The constitutional review led to the election of the Honorary Secretary role directly by the membership. A list of the BSSH elected and representative roles and term dates has been made widely available on the website. The impact of these changes is that the BSSH saw an increase in the number of applications received for vacant posts in 2021/2022. 

## **FINANCIAL REVIEW** 

## **Financial results of activities and events** 

During the year, the Society generated £855,555 (2020/2021: £904,249) of income and incurred expenditure of £967,076 (2020/2021: £864,877) principally disseminating information as it relates to any and all of the fields that pertain to the Society’s charitable objectives. In terms of the Society’s ongoing activities, subscription income increased from the prior year to £199,414 (2020/2021: £184,403). Journal income decreased by £94,446 (2020/2021: increased by £51,985). Income from meetings, courses and events increased to £113,719 (2020/2021: decreased to £52,692). 

After grant giving, an overall deficit of £111,521 (2020/2021: an overall surplus of £39,372) resulted for the year, before taking gains and losses on investment assets into consideration. The performance of the Society’s investments in 2021/2022 was acceptable in the current economic environment but did result in an overall decrease in value of £49,255 (2020/2021: increase in value £253,572). At the balance sheet date, the charitable company had net current assets of £16,900 (31 May 2021: £128,809), and overall net assets of £2,320,020 (31 May 2021: £2,480,766). 



**Page 12** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

## **Grant making** 

Grants, awards and prizes totalling £133,180 (2020/2021: £125,797) were recognised as resources expended following consideration of awards by the recommendation of the Research and Education and Training, subcommittees and Council. Grants for 2021/2022 comprised the following: 

£ Research Support Grants 84,225 Joint RCS and BAPRAS Surgical Champion 14,375 Clinical Leaders Programme (BOA) 8,400 Educational grants 2,500 Medical Student Elective Bursaries 4,500 BAHT Bursary 500 Joint BSSH/Scar Free Foundation Medical Elective Awards 600 BSSH Education and Travel Bursary 11,500 Pulvertaft Prize 3,000 Educational Presentation Prize 1,500 Other grants, prizes and awards 2,080 _______ 133,180 

## **Reserves policy** 

At 31 May 2022, the charity’s ‘free reserves’ amounted to £2,320,020 (31 May 2021: £2,480,766). 

The trustees have completed a detailed review of forecast levels of income, taking into account the reliability of each source of income and the prospects for developing new income sources. The trustees have also completed a review of current spending plans. The trustees have concluded that there will be scope for funding additional grants, awards and prizes to take advantage of future needs and opportunities. Among other things, the trustees' reserves policy is designed to enable those additional activities to be undertaken with confidence by ensuring that the Society's reserves are sufficient to absorb any shortfall in income, with minimal or no impact on beneficiaries. 

## **Investments policy** 

The trustees have wide ranging powers to invest the funds of the Society as they see fit, and in practice, they receive advice from the Society’s investment managers on appropriate investments. In addition, any short-term surplus cash funds are held in interest bearing deposit accounts. 

In line with the requirements of the Society’s reserves policy, the trustees’ investment strategy is to seek income growth whilst maintaining capital in real terms at a target value of £2.5 million. The performance of the Society’s investments against this policy is reviewed by the trustees throughout the year. The trustees will not invest in anything that they consider to be socially, environmentally or ethically unsound in any way. 

At 31 May 2022, the charity’s investment portfolio had a market value of £2,283,873 (31 May 2021: £2,333,098), and during 2021/2022, generated investment income of £86,052 (2020/2021: £113,612). For the year ended 31 May 2022, the charity’s investments portfolio grew in value by 2.1% (2020/2021: increased in value by 11.9%), and achieved an average gross income return of 3.76% (2020/2021: 4.87%) and an average net income return (after investment management costs) of 3.3% (2020/2021: 4.2%). 

The charity’s cash deposits achieved an average income return of 0.4% (2020/2021: 0.1%). 



**Page 13** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

**TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

## **PLANS FOR FUTURE PERIODS** 

## **Review of Society strategic direction** 

Following the last strategy day in 2017, the Society will review its strategic direction again in 2023. The Society aims to consult as many of its members as possible as part of this review. Following feedback, an organisational strategic plan with relevant actions will be drawn up. 

## **Events** 

Having been successful in the bid to host the 2022 IFSSH Congress, the Society will jointly host this meeting in June 2022 both in London and online. The Society hopes to attract over 4,000 delegates to this event as well as run a fellowship programme for 33 individuals from across the world enabling them to visit hand surgery centres of excellence in the UK and develop professional networks. 

The Society will holding its Autumn Scientific meeting in October 2022 in Winchester. 

The eighth series of Instructional Courses will continue in Manchester with 8.6 Fracture Management and Joint Injuries to be held on 9-10 September 2022 and 8.7 Dupuytren’s Disease and Paralysis held in February 2023. 

The Trauma Committee will hold a joint Trauma Symposium in 2023 with the British Association of Hand Therapists (BAHT). The Symposium will examine the whole pathway to improve outcomes in boxer fractures, scaphoid fractures and nail bed injuries and will be advertised to all medical professionals involved in hand trauma care. 

## **Financial and Business plan** 

The Society will further engage with the Cranfield Trust to conduct a review into its financial and business planning processes with a view to strengthen these where required. The Society has already approved the creation of a Financial Audit and Risk Committee to help oversee this. 

## **Lilongwe Institute for Orthopaedics and Neurosurgery (LION) Hand unit** 

The Society has committed £100,000 to help with first year costs to set up a hand unit in Lilongwe, Malawi. This five-year project with BAHT will assist LION in the delivery of treatment for elective and traumatic conditions of the hand. 

## **Fundraising** 

The Society would like to optimise its financial potential by exploring fundraising opportunities. 

## **Impact of future activities and events** 

The trustees will continue to principally assess the success of the above activities and events by evaluating the: 

- Membership levels 

- Interest in Trustee and Committee roles 

- Number of papers submitted to and delegates meetings and courses 

It is the trustees’ aim that membership levels should not fall significantly below the current levels of 858. This compares to 2020/2021 when there were 921 members. It is hoped the review of membership categories introducing Associate Specialist doctors, medical students and core and junior trainees will further increase these figures. 

In addition, the number of delegates attending the Autumn and Spring Meetings should not fall significantly below the most recent levels of 250. The number of delegates attending meetings continues to increase since the format has changed to include online attendance in certain cases. 



**Page 14** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

It is hoped that the IFSSH Congress will attract over 4,000 delegates although the impact of the pandemic may affect this number. The trustees have carefully considered the potential financial impact of the meeting if it should be cancelled. Where possible, plans have been put in place to mitigate potential losses, including the contract negotiations and the introduction of a virtual or hybrid option if required. 

The number of papers presented at the scientific meetings should not fall below the most recent levels. 36 papers were presented at the 2021 meeting in Oxford. 

The trustees’ continue to agree to underwrite the Instructional Courses in hand surgery up to £10,000 each should they not make a surplus. The courses run during this period made a loss of £3,121, due to the conversion of a face to face course to virtual. 

## **Public benefit** 

In the future, the trustees intend to ensure that BSSH continues to benefit the public by continuing to ensure the charity’s activities promote education, training and research in the specialty. The BSSH will create a working group to improve the BSSH Patient Information, improving its accessibility and obtain the Patient Forum Association (PFA) gold standard accreditation. 

## **REFERENCE AND ADMINISTRATIVE DETAILS** 

## **The Council of the Society** 

The trustees of the charity, who are also the directors of the company, are the elected officers and members of the Council of the Society, who have served on the Council since 1 June 2021, as follows: 

|J L Hobby|**President**(from 1 January 2021),**Vice President**(until 31 December 2021)|
|---|---|
|S M Fullilove|**Immediate Past President**(from 1 January 2021),**President**(until 31 December 2021)|
|D E Boyce|**Vice President**(from 1 January 2021),|
|D Warwick|**Immediate Past President**(until 31 December 2021)|
|I S H McNab|**Honorary Secretary & Company Secretary 2020-2022**(from 1 January 2020)|
|D E Boyce|**Honorary Treasurer 2020-2022**(appointed 1 January 2020)|
|M Birks|**2019-2021 (demitted December 2021)**|
|G Bourke|**2019-2021 (demitted December 2021)**|
|C Little|**2019-2021 (demitted December 2021)**|
|D Brown|**2020-2022**|
|M Horwitz|**2020-2022**|
|G Smith|**2020-2022**|
|D Clark|**2021-2023**|
|A Mishra|**2021-2023**|
|L Muir|**2021-2023**|
|J McEachan|**2022-2024 (appointed January 2022)**|
|R Shirley|**2022-2024 (appointed January 2022)**|
|S Talwalkar|**2022-2024 (appointed January 2022)**|



The principal address of the charity and the registered office of the company is the secretariat offices of the Society at The Royal College of Surgeons of England, 38 - 43 Lincoln’s Inn Fields, London WC2A 3PE. 

The charity is registered under the charity number 268396, and the company is incorporated with the company registration number 01213983. 



**Page 15** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

The Society has made the following professional appointments: 

|Solicitor:|Radcliffes Le Brasseur, 5 Great College Street, Westminster, London SW1P 3SJ|
|---|---|
|Accountant:|RSM UK Tax and Accounting Limited, Third Floor, One London Square,|
||Cross Lanes, Guildford, Surrey GU1 1UN|
|Independent examiner:|Kerry Gallagher, FCA DChA of RSM UK Tax and Accounting Limited,|
||Davidson House, Forbury Square, Reading, Berkshire RG1 3EU|
|Investment Managers:|Sarasin & Partners LLP, Juxon House, 100 St Paul’s Churchyard,|
||London EC4M 8BU|
||Cazenove Capital the trading name of Schroder & Co. Limited,|
||1 London Wall Place, London EC2Y 5AU|
|Bankers:|National Westminster Bank plc, PO Box 2021, 10 Marylebone High Street,|
||London W1U 4BT|
||Lloyds TSB Bank plc, Southampton Row Branch, Victoria House,|
||Southampton Row, London WC2B 5HR|
||CCLA Investment Management Limited, 85 Queen Victoria Street,|
||London EC4V 4ET|
||National Westminster Bank plc, Nottingham University Branch,|
||Portland Building, Level C University Park, Nottingham NG7 2AG|
||Scottish Widows Bank Plc, P O Box 12757, 67 Morrison Street,|
||Edinburgh EH3 8YJ|



The trustees of the charity are assisted and advised by the following individuals, who are co-opted to the Council, and in that capacity, are neither trustees of the charity nor directors of the company: 

|S Hodgson|Honorary Archivist (2021 - 2025)|
|---|---|
|D J Shewring|Chair of the Committee of Management for the Journal of Hand surgery|
||(European Volume) (2016 - 2021)|
|G E B Giddins|Chair of the Committee of Management for the Journal of Hand surgery|
||(European Volume) (2022 - 2026)|
|J B Tang|Editor in Chief (demitted 2021)|
|W Lam|Editor in Chief (2022-2025)|
|J Arrowsmith|Chair of the Education and Training Committee (2020-2021)|
|M Birks|Chair of the Education and Training Committee (2022-2024)|
|D Furniss|Chair of the Research Committee and Scar Free Foundation (2019-2022)|
|J Rodrigues|Chair of the Audit Committee (2020 - 2022)|
|J Jones|Chair of the Overseas Committee (2020 - 2022)|
|S Tucker|Chair Trauma Committee (2019-2022)|
|Z Naqui|Chair of the Communications Committee (2020-2022)|
|C Y Ng|Chair Interface Committee in Hand Surgery (2021-2023)|
|G Smith|Representative for FESSH and IFSSH(2022-2024)|
|D Furniss|Representative for the Research Board of the Scar Free Foundation|
|M David|Webmaster|





**Page 16** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

The following key senior members of staff are responsible for the day-to-day management of the Society: 

Mrs Charlotte Smith Head of Secretariat Miss Kavita Prashar Events Manager Miss Emma Brighton Communication and Charitable Development Manager Ms Ruth Neave Diploma and Committee Coordinator Ms Sharon Ross Audit Database and Membership Coordinator Ms Wendy Patterson Journal Manager Ms Abigail Bradley Journal Assistant Ms Judy Richards Finance Coordinator 

## **STRUCTURE, GOVERNANCE AND MANAGEMENT** 

## **Status and history** 

BSSH is a registered charity, and a company limited by guarantee, not having share capital. Every member undertakes to contribute an amount not exceeding £1 to the assets of the Society in the event of the Society being wound-up during the period of membership, or within one year thereafter. 

The Society was founded in 1968 with the aim of relieving sickness and protecting and preserving public health by the promotion and development of hand surgery. 

The Society was incorporated on 28 May 1975 and became a registered charity on 22 August 1975. BSSH is governed by its rules and regulations, as set down in the company’s Memorandum and Articles of Association (Constitution), which were originally adopted on 28 May 1975 were last updated on 3 November 2005 and are currently undergoing review. 

## **Organisational Structure** 

The overall strategic direction of the charity is determined by the trustees, who are assisted and advised by coopted members of the Council, and by the non-trustee members of the various BSSH subcommittees. The subcommittees of the Society are used to focus discussion on issues pertaining to their particular roles and titles, and these subcommittees then report and submit recommendations to the Council. 

The Council comprises the President, the Vice-President, the Immediate Past President, the Honorary Secretary, the Honorary Treasurer and currently nine elected full members serving for a three-year period. 

The Council currently meets three to four times a year, and the Chairpersons of the Society’s subcommittees are all co-opted members of the Council. 

The day-to-day management of the Society has been delegated by the trustees to a team of staff reporting to the Head of Secretariat. 

## **Policy for remunerating senior staff and key management personnel** 

The pay of the staff, including key management personnel, is set by the trustees following a review by and upon the advice of an external human resources company (Persona People Management Ltd) which derives its recommendations from external benchmarks. The benchmarks used check pay levels of similar staff in similar posts with those of similar sized entities and, in particular, similar charities. 



**Page 17** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

## **Subcommittees** 

The Society operates the following subcommittees, and the following individuals have served on the subcommittees during the year under review: 

|**Communications Committee**<br>Z Naqui<br>M Horwitz<br>M David<br>N Fine<br>W Khor<br>R Trickett|**Diploma and Masters Committee**<br>H Hedley<br>A J Logan<br>M Akhavani<br>S Ankarath<br>C Baldwin<br>I Chakrabarti<br>P Russell<br>M Brewster<br>A Pandya<br>C Pailthorpe|
|---|---|
|**Research Committee**<br>D Furniss<br>B Dean<br>J Nanchahal<br>N Johnson<br>J Lane<br>R Dolan<br>M Gardiner<br>E Reay<br>A Karantana<br>D Kennedy<br>R Horton<br>P Rust<br>R Wade|**Education and Training Committee**<br>J Arrowsmith<br>M Birks<br>I Chakrabati<br>H Dafydd<br>A Kocheta<br>V Bhalaik<br>J Molyneux<br>N Riley<br>R Shirley<br>L Sayed<br>CY Ng<br>J Chan<br>C Simpson<br>A Hunter|
|**Trauma Committee**<br>S Tucker<br>J Bedford<br>S Hettiaratchy<br>W Mason<br>I McNab<br>K Owers<br>A De Leo<br>M Potts<br>S Mee<br>E Bamford<br>R Baker<br>G Goodwill<br>D Edwards<br>A Jester<br>L Reid|**Audit Committee**<br>J Rodrigues<br>C Little<br>E Reay<br>A Bremner-Smith<br>M Gardiner<br>P Stirling<br>R Wade<br>S Ross<br>T Davis<br>T Quick<br>A Lupu|





**Page 18** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

|**Instructional Course Organising Committee**<br>D Clark<br>P P Grieve<br>R J I Colville<br>S Gidwani<br>M Calcagni<br>M Lamyman<br>J McEachan<br>W Lam<br>E Davidson<br>L Sayed<br>**Cadaveric Subcommittee**<br>Z Naqui<br>G Bourke<br>M Akhavani|**Committee of Management for the Journal**<br>D Shewring<br>G E B Giddins<br>D Boyce<br>J H Coert<br>D Herren<br>I McNab<br>J Hobby<br>W Lam<br>G Leblebicioglu<br>Z Naqui<br>J B Tang<br>D Warwick|
|---|---|
|**Editorial Board for the Journal**<br>S Ankarath<br>T B Hansen<br>J Bland<br>M Calcagni<br>K Chung<br>N Downing<br>S Fullilove<br>C Heras-Palou<br>N Hollevoet<br>J Hopkinson-Woolley<br>S Hovius<br>C Jerosch-Herold<br>G Leblebicioglu<br>I Leslie<br>B Liu<br>A Logan<br>S Luria<br>J McEachan<br>C Meals<br>C Pailthorpe<br>J Rodrigues<br>A Ross<br>R Sanchez-Rosales<br>A Smith<br>M Solomons<br>R Trickett<br>P Werker|**Overseas Committee**<br>J Jones<br>C Mariathas<br>M Waldram<br>S Deshmukh<br>N Lloyd<br>R Taha<br>M Glover<br>W Lam<br>D Bell<br>F Iwuagwu<br>M Ricks<br>D Warwick<br>S Sarker<br>D Izadi<br>J Stanton<br>M Wood<br>T Barabas<br>P Smith<br>**Overseas Trainee Committee**<br>R Taha<br>A Gough<br>H Abed<br>D Osei-Kuffour<br>A Vaughan<br>S Thomson<br>H Benjamin-Laing<br>D Bodansky|





**Page 19** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

**TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

## **Method of Recruitment, Appointment, Election, Induction & Training of Trustees** 

The trustees of the charity are the officers and elected members of the Council of the Society. 

The Members of the Society are notified of forthcoming vacancies for elected Council members and invited to stand for election. Each nomination is proposed and seconded by Members, and each nominee provides written consent and a synopsis of why he/she wishes to become a Council member. New Council members are then elected by the Members through an on-line voting system. The list of candidates will then be put to Members for election with a single transferable vote methodology used until a candidate achieves a majority. Votes will be counted for each sub-speciality applicant individually, and then having excluded the highest ranked applicant from each sub-speciality, as a group as a whole. Successful candidates are announced at the Autumn AGM. 

Recommendations for President are sought from the members in January each year and those recommended are then invited to apply. The President is elected by the Council at the spring meeting by a closed online vote using a single transferrable vote methodology. The successful applicant is then recommended to the members at the AGM for ratification. 

Applications for Honorary Treasurer are sought from Full Members of the Society by means of an application form during January of the incumbent Treasurer’s 3rd year of office. The Treasurer is elected by the council at the spring meeting of the incumbent Treasurer’s 3rd year of office, by a closed online vote using a single transferrable vote methodology. The successful applicant is then recommended to the members of the society at the AGM for ratification. 

Applications for Honorary Secretary are sought from Full Members of the society in January of the incumbent Secretary’s third year of office by means of an application form. Applications are short-listed by the officers and elected members of council using criteria including commitment to hand surgery, education and research; previous involvement with the society and any other information in the application form. The short-list of candidates will then be put to the voting members of the society, with a single transferable vote methodology used. The successful candidate is announced to the Society at the Spring Meeting EGM. 

The President serves for one year, preceded by one year as Vice-President and one year as Vice-President Elect. The President remains on Council for one further year as the Immediate Past President. The Honorary Secretary serves for three years and the Honorary Treasurer serves for four years. 

In line with the recommendations of the Charity Commission, an induction manual for trustees of the Society is produced. This comprehensive manual details the activities of the Society and informs trustees of their terms of reference and continuing responsibilities. All new trustees are provided with a copy of the induction manual containing Trustees’ Code of Conduct, Officers’ Job Descriptions, subcommittee Terms of Reference, the Society Policies, the Constitution, Risk Assessment, calendar of activities and relevant Charity Commission guidance. The Society also runs annual trustee training and refresher sessions. 

## **Professional Indemnity Insurance** 

The charity has taken out an insurance policy that provides professional indemnity cover for the trustees. This policy provides trustee and Charity, clubs and associations legal liability cover of up to £5 million in respect of any one claim. The cost of this insurance for the year was £4,257 (2020/2021: £3,229). 



**Page 20** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

## **Risk & Corporate Governance Matters** 

The Society does not need to expose itself to a high level of risk in order to achieve its present objectives. Therefore, an overall medium level of risk is accepted as a matter of policy. It may prove necessary to change this policy at a later date depending on initiatives recommended by the membership and implemented by the trustees. 

The President and Secretariat undertake an annual Risk Review and the results are then scrutinised by the trustees. The Risk Review is a standing item on the agenda at the Autumn meeting of Council. Any significant changes in the Society’s risk profile are presented to the membership at the Annual General Meeting. During this period, a review took place in September 2021. 

This review at this time identified the below medium risk areas and agreed the following mitigation actions: 

- The loss of key staff following the secretariat split: 

   - Ensure cross training of staff and hand over periods. 

- Exposure to volatility in the markets in relation to the Society’s substantial investment portfolio, particularly owing to the global pandemic and economic situation: 

   - Monitoring investment risk on a continuous basis by regular reviews with the Society’s investment managers. 

- 

   - Potential cost of IFSSH Meeting in June 2022. 

      - High cost contracts, such as catering will not be signed until shortly before the event. 

      - Work closely in partnership with the Professional Conference Organiser, Asszisztencia to develop a plan to convert the meeting to a virtual one should travel restrictions be in place due to the ongoing pandemic. 

      - Close monitoring of the global situation and cancellation in good time if required to maximise refunds on any deposits paid. 

- 

- Pension shortfall 

   - Employer contributions will be increasing from 16%, to 21%. This will be phased, moving to 19% from January 2022 and then 21% from January 2023. This increase to be taken into account with future financial planning 

All other remaining risks listed on the register are rated low. These remaining risks whilst being kept under review are not sufficient cause for concern to be in need of active day-to-day management. 

## **Trustees’ Responsibilities in the Preparation of Financial Statements** 

The trustees (who are also the directors of The British Society for Surgery of the Hand) for the purposes of company law) are responsible for preparing the trustees’ annual report and the financial statements in accordance applicable law and regulations. 

Company law requires the trustees to prepare financial statements for each financial year. Under that law, the trustees have prepared the financial statements in accordance with United Kingdom Generally Accepted Accounting Practice (United Kingdom Accounting Standards and applicable law). 

Under company law, the trustees must not approve the financial statements unless they are satisfied that they give a true and fair view of the state of affairs of the charitable company as at the balance sheet date, and of its income and expenditure for that period. 



**Page 21** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

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

- select suitable accounting policies and then apply them consistently; 

- observe the methods and principles in the Charities SORP; 

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

- state whether applicable UK Accounting Standards have been followed subject to any material departures disclosed and explained in the financial statements; and 

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

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

The trustees are responsible for the maintenance and integrity of the corporate and financial information included on the charitable company’s website. Legislation in the United Kingdom governing the preparation and dissemination of financial statements may differ from the legislation in other jurisdictions. 

## **Independent Examiner** 

Kerry Gallagher FCA DChA of RSM UK Tax and Accounting Limited has indicated her willingness to continue in office. 

## **FUNDS HELD AS CUSTODIAN** 

Although the Society maintains restricted funds to deal with incoming resources that are earmarked for a particular purpose by donors, sponsors, and other funders, BSSH does not currently hold, and the trustees do not anticipate that it will in the future hold, any funds as custodian for any third party. 

This report was approved by the trustees on 20th January 2023, and was signed for and on behalf of the board by: 

**Honorary Secretary & Company Secretary** I S H McNab 

Date: 20/01/2023 



**Page 22** 

## **INDEPENDENT EXAMINER’S REPORT TO THE TRUSTEES OF THE BRITISH SOCEITY FOR SURGERY OF THE HAND** 

I report to the trustees on my examination of the financial statements of the British Society for Surgery of the Hand (the charitable company) for the year ended 31 May 2022, which are set out on pages 23 to 34. 

## **Responsibilities and basis of report** 

As the trustees of the charitable company (and also its directors for the purposes of company law) you are responsible for the preparation of the financial statements in accordance with the requirements of the Companies Act 2006 (‘the 2006 Act’). 

Having satisfied myself that the financial statements of the charitable company are not required to be audited under Part 16 of the 2006 Act and are eligible for independent examination, I report in respect of my examination of your charitable company’s financial statements as carried out under section 145 of the Charities Act 2011 (‘the 2011 Act’). In carrying out my examination, I have followed the Directions given by the Charity Commission under section 145 (5)(b) of the 2011 Act. 

An independent examination does not involve gathering all the evidence that would be required in an audit and consequently does not cover all the matters that an auditor considers in giving their opinion on the financial statements. The planning and conduct of an audit goes beyond the limited assurance that an independent examination can provide. Consequently, I express no opinion as to whether the financial statements present a ‘true and fair view’ and my report is limited to those specific matters set out in the independent examiner’s statement. 

## **Independent examiner’s statement** 

Since the company's gross income exceeded £250,000 your examiner must be a member of a body listed in section 145 of the 2011 Act. I confirm that I am qualified to undertake the examination because I am a member of The Institute of Chartered Accountants in England and Wales, which is one of the listed bodies. 

I have completed my examination. I confirm that no material matters have come to my attention in connection with the examination giving me reasonable cause to believe that in any material respect: 

1. accounting records were not kept in respect of the charitable company as required by section 386 of the 2006 Act; or 

2. the financial statements do not accord with those records; or 

3. the financial statements do not comply with the accounting requirements of section 396 of the 2006 Act other than any requirement that the financial statements give a ‘true and fair view’ which is not a matter considered as part of an independent examination; or 

4. the financial statements have not been prepared in accordance with the methods and principles of the Statement of Recommended Practice: Accounting and Reporting by Charities applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Ireland (FRS 102). 

I have no concerns and have come across no other matters in connection with the examination to which attention should be drawn in this report in order to enable a proper understanding of the financial statements to be reached. 

## Kerry Gallagher 

Signed: ………………………………………… 

Name: Kerry Gallagher FCA DChA Name of applicable listed body: The Institute of Chartered Accountants in England and Wales Relevant professional qualification or membership of professional body: Chartered Accountant 

ON BEHALF OF RSM UK TAX AND ACCOUNTING LIMITED 

Chartered Accountants Davidson House, Forbury Square, Reading, Berkshire RG1 3EU 

25/01/23 Date: ……………………………. 



**Page 23** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **STATEMENT OF FINANCIAL ACTIVITIES (including Income and Expenditure Account) for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

|||**Unrestricted Funds**|**Unrestricted Funds**|
|---|---|---|---|
|||**Total**|**Total**|
|||**2022**|**2021**|
||**Notes**|£|£|
|**INCOME FROM:**||||
|**Charitable activities**||||
|Disseminating information on the specialty|2|769,433|790,601|
|**Investments**|3|86,122|113,648|
|||________|________|
|**TOTAL**||855,555|904,249|
|**EXPENDITURE ON:**||||
|**Raising funds**||||
|Investment management fees||(10,047)|(16,901)|
|**Charitable activities**||||
|Disseminating information on the specialty|4|(957,029)|(847,976)|
|||________|________|
|**TOTAL**||(967,076)|(864,877)|
|Net (losses)/gains on investments|7|(49,225)|253,573|
|||________|_______|
|**NET (EXPENDITURE)/INCOME AND NET MOVEMENT IN FUNDS**||(160,746)|292,945|
|**RECONCILIATION OF FUNDS**||||
|Total funds brought forward at 1 June 2021||2,480,766|2,187,821|
|||________|________|
|**TOTAL FUNDS CARRIED FORWARD AT 31 MAY 2022**|11|2,320,020|2,480,766|
|||========|========|





**Page 24** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

|**BALANCE SHEET**||||
|---|---|---|---|
|**as at 31 May 2022**||Company Number:|01213983|
|___________________________________________________________________________________________||||
|||**2022**|**2021**|
||**Notes**|£|£|
|**FIXED ASSETS**||||
|Investments|7|2,303,120|2,351,957|
|**CURRENT ASSETS**||||
|Debtors|8|139,933|152,127|
|Cash at bank and in hand||101,721|314,014|
|||_______|_______|
|||241,654|466,141|
|**LIABILITIES**||||
|Creditors: Amounts falling due within one year|9|(224,754)|(337,332)|
|||_______|_______|
|**NET CURRENT ASSETS**||16,900|128,809|
|||________|________|
|**TOTAL ASSETS LESS CURRENT LIABILITIES & NET ASSETS**||2,320,020|2,480,766|
|||========|========|
|**THE FUNDS OF THE CHARITY**||||
|**Unrestricted income funds**||||
|General fund|11|2,320,020|2,480,766|
|||________|________|
|**TOTAL CHARITY FUNDS**||2,320,020|2,480,766|
|||========|========|



For the year ended 31 May 2022, the charitable company was entitled to exemption from audit under section 477 of the Companies Acts 2006 (the Act) relating to small companies and the members have not required the charitable company to obtain an audit of its financial statements for the year in question in accordance with section 476 of the Act. 

The trustees acknowledge their responsibility to keep accounting records in accordance with section 386 of the Act and for preparing financial statements which give a true and fair view of the state of affairs of the charitable company as at 31 May 2022 and of its result for the year then ended in accordance with sections 394 and 395 of the Act and which otherwise comply with the requirements of the Act, so far as applicable to this charitable company. 

These financial statements have been prepared in accordance with the provisions applicable to companies subject to the small companies’ regime. 

The financial statements on pages 23 to 34 were approved by the trustees and authorised for issue on 20th January 2023, and are signed on their behalf by 

…………………………………. **President** …………………………………. **Honorary Treasurer** J Hobby D E Boyce 

Date: 20/01/2023 

Date: 20/01/2023 



**Page 25** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

**STATEMENT OF CASH FLOWS for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

|||**2022**|**2021**|
|---|---|---|---|
||**Notes**|£|£|
|**CASH FLOWS FROM OPERATING ACTIVITIES:**||||
|Net cash used in operating activities|12|(298,027)|(212,136)|
|**CASH FLOWS FROM INVESTING ACTIVITIES:**||||
|Dividends, interest and rents from investments||86,122|113,648|
|Proceeds from the disposal of investments||-|60,010|
|Cost of purchases of investments||-|(56)|
|||_______|_______|
|Net cash used in investing activities||(211,905)|(38,534)|
|||_______|_______|
|**CHANGE IN CASH AND CASH EQUIVALENTS IN THE**||||
|**REPORTING PERIOD**||(211,905)|(38,534)|
|Cash and cash equivalents at the beginning of the||||
|reporting period||332,873|371,407|
|||_______|_______|
|**CASH AND CASH EQUIVALENTS AT THE END OF THE**||||
|**REPORTING PERIOD**|13|120,968|332,873|
|||=======|=======|





**Page 26** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **NOTES TO THE FINANCIAL STATEMENTS for the year ended 31 May 2022** 

## 1. **ACCOUNTING POLICIES** 

## **Company information** 

The British Society for Surgery of the Hand (the charitable company) is a private company limited by guarantee incorporated in England and Wales. The registered office and principal place of business is at The Royal College of Surgeons of England, 38/43 Lincoln’s Inn Fields, London WC2A 3PE. The charitable company’s principal activities are disclosed in the trustees’ annual report. 

## **Basis of accounting** 

These financial statements have been prepared in accordance with FRS 102 “The Financial Reporting Standard applicable in the UK and Republic of Ireland” and under the historical cost convention, except as modified for the annual revaluation of fixed asset investments. 

Within the definitions of FRS 102, the charity is a public benefit entity. 

The financial statements have been prepared in accordance with the accounting policies set out in more detail below and comply with the Charities Act 2011, the Companies Act 2006, the Memorandum and Articles of Association of the charitable company, 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 UK and Republic of Ireland (FRS 102) (effective 1 January 2019). 

## **Going concern** 

Despite the loss for the year, having sought appropriate assurances in the form of forecasts and action plans, the trustees have a reasonable expectation that the charitable company will continue in operational existence for the foreseeable future and be able to meet all of its financial obligations as they fall due for a period of at least twelve months from the date of approval of these financial statements. 

Based on these forecasts and action plans, the trustees consider it is appropriate for the financial statements to be prepared on the going concern basis. The financial statements do not include any adjustments that would result should the going concern basis of preparation not be appropriate. In the event that this basis is not appropriate provisions may be required and assets may need to be written down to their recoverable amount. 

## **Income** 

General donations and other similar types of voluntary income are brought into account when receivable. Donated income is included gross of any attributable tax recoverable, where relevant. Donations given for specific purposes are treated as restricted income. 

Investment income is also accounted for on a receivable basis once the dividend has been declared or interest has been earned. Credit is taken in the accounts for the proportion of subscriptions, which are receivable in the financial period. All other similar types of income are accounted for on an accruals’ basis. 



**Page 27** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **NOTES TO THE FINANCIAL STATEMENTS** (Continued) **for the year ended 31 May 2022** 

## 1. **ACCOUNTING POLICIES** (Continued) 

## **Expenditure** 

Expenditure is allocated to the charitable company’s principal activity where the costs can be identified as being directly related to that activity. All costs that cannot be identified as relating directly to the charitable company’s principal activity are categorised as either support costs or governance costs. Any costs that cannot be specifically categorised are allocated in proportions based upon a suitable ratio applicable to the nature of the cost involved. 

Grants payable are recognised in the period in which the approved offer is conveyed to the recipient except in those cases where the offer is conditional, such grants being recognised only when the conditions attaching to the award are fulfilled. Grants offered subject to conditions, which have not been met at the balance sheet date, are noted as a potential commitment, but are not treated as a liability. 

## **Taxation** 

The charitable company is a registered charity and as such its income and gains falling due under section 471 to 489 of the Corporation Tax Act 2010 or section 256 of the Taxation of Chargeable Gains Act 1992 are exempt from corporate tax to the extent that they are applied to its charitable objectives. 

## **Investments** 

The charitable company’s investments are included in the balance sheet at fair value (their market value). The gains or losses arising upon their annual revaluation are included in the statement of financial activities. 

## **Liabilities** 

A contingent liability is disclosed for those grants, which do not represent liabilities, where the possible obligation, which arises from past events, will only be confirmed by the occurrence of one or more uncertain future events not wholly within the trustees’ control. Provisions are recognised for those grants where there is uncertainty as to the timing or amount, and any uncertainty regarding the amount is more than one of the determining factors for reasonable estimation of the liability arising from that constructive obligation. 

## **Financial instruments** 

A financial instrument is a contract that gives rise to a financial asset of one entity and a financial liability or equity instrument of another entity. Financial instruments are therefore classified and accounted for according to the substance of the contractual arrangement as financial assets, financial liabilities or equity instruments. An equity instrument is any contract that evidences a residual interest in the assets of the entity after deducting all of its liabilities. 

## **Financial assets and liabilities** 

The charitable company’s debtors and creditors that meet the definition of either a financial asset or a financial liability are initially recognised at the transaction value and thereafter are stated at amortised cost using the effective interest method. 



**Page 28** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **NOTES TO THE FINANCIAL STATEMENTS** (Continued) **for the year ended 31 May 2022** 

## 1. **ACCOUNTING POLICIES** (Continued) 

## **Pension contributions** 

The charitable company participates in a multi-employer defined benefit pension scheme known as the Superannuation Arrangements of the University of London (“SAUL”). The scheme is contracted out of the State Earnings-Related Pension Scheme and is a centralised scheme for certain employees with the assets held in separate trustee-administered funds. 

The charitable company is unable to identify its share of the underlying assets and liabilities of the scheme. Accordingly, the amount charged to the statement of financial activities in respect of pension costs is the total contributions payable for the year. 

## **Fund accounting** 

The general fund comprises the accumulated surpluses of unrestricted income over expenditure, which are available for use in furtherance of the general objective of the charitable company. 

Designated funds are a particular form of unrestricted fund consisting of amounts which have been allocated or designated for specific purposes by the trustees. The use of designated funds remains at the discretion of the trustees. 

Restricted funds are comprised of amounts subject to specific conditions imposed by donors or other types of funder. The purpose and use of restricted funds are set out in the notes to the financial statements. Amounts unspent at the year end are carried forward in the balance sheet. 

|2.|**INCOME FROM DISSEMINATING**|**2022**|**2021**|
|---|---|---|---|
||**INFORMATION ON THE SPECIALTY**|**£**|**£**|
||Subscription income from members|199,414|184,403|
||Journal income|427,584|522,030|
||Income from meetings, courses and events|113,719|52,692|
||Hand Diploma income|28,350|26,775|
||Grant income|-|4,500|
||Other income|366|201|
|||_______|_______|
|||769,433|790,601|
|||=======|=======|
|3.|**INVESTMENTS**|**2022**|**2021**|
|||**£**|**£**|
||Bank interest receivable on short term cash deposits|70|36|
||Income from investments listed on a recognised stock|||
||exchange in the UK|86,052|113,612|
|||_______|_______|
|||86,122|113,648|
|||=======|=======|





**Page 29** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **NOTES TO THE FINANCIAL STATEMENTS** (Continued) **for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

|4.|**COSTS OF DISSEMINATING**|||**2022**|**2021**|
|---|---|---|---|---|---|
||**INFORMATION ON THE SPECIALTY**|||**£**|**£**|
||Direct costs:|||||
||Membership costs|||34,033|37,967|
||Journal expenditure|||104,313|107,655|
||Meetings, courses and events expenditure|||196,521|69,277|
||Hand Diploma costs|||16,200|8,000|
||Grants, bursaries and prizes awarded to 21|||||
||(2020/2021: 15) individuals|||133,180|125,797|
||Website and public relations costs|||7,842|11,165|
||Other direct costs|||5,515|760|
|||||_______|_______|
|||||497,604|360,621|
||Support and governance costs (see note 5)|||459,425|487,355|
|||||________|________|
|||||957,029|847,976|
|||||========|========|
|5.|**SUPPORT & GOVERNANCE COSTS**|**Support**|**Governance**|**Total**|**Total**|
|||**costs**|**costs**|**2022**|**2021**|
|||£|£|£|£|
||Staff costs (see note 6)_(95:5)_|299,169|15,746|314,915|326,114|
||Premises - operating lease costs_(95:5)_|9,663|509|10,172|4,320|
||Office overheads_(95:5)_|48,585|2,557|51,142|36,785|
||Legal and professional fees_(95:5)_|7,267|382|7,649|27,376|
||Fees payable to the independent examiner:|||||
||- Independent exam fees_(0:100)_|-|2,950|2,950|2,750|
||- Tax compliance services_(0:100)_|-|7,000|7,000|-|
||- Other governance costs_(0:100)_|-|995|995|-|
||- Other financial services_(90:10)_|40,164|4,463|44,627|77,760|
||Irrecoverable VAT_(95:5)_|18,961|998|19,959|12,250|
||Foreign exchange loss (_95:5_)|15|1|16|-|
|||_______________________________|||_______|
|||423,824|35,601|459,425|487,355|
|||===============================|||=======|



The above costs are allocated between support costs and governance costs using the ratios shown in italic in each case. Where not otherwise calculated, the ratio used follows the allocation of staff costs, for which 5% is considered to be the amount of staff time relating to governance matters. 

During the current year, eight trustees were reimbursed for travel and subsistence expenses totalling £8,253, £393 for purchasing gifts, £80 for meeting costs and £213 for other miscellaneous expenses (2020/2021: no trustees were reimbursed for any expenses). 



**Page 30** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **NOTES TO THE FINANCIAL STATEMENTS** (Continued) **for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

|6.|**STAFF COSTS**|**2022**|**2021**|
|---|---|---|---|
|||No.|No.|
||The average monthly number of persons employed by the Society|||
||(excluding Council members) during the year was, as follows:|||
||Secretariat office|8|8|
|||==|==|
|||£|£|
||Staff costs for the above persons:|||
||Wages and salaries|250,687|258,961|
||Social security costs|17,687|25,422|
||Other pension costs|38,860|37,818|
||Health insurance costs|4,091|3,068|
||Other staff costs|3,590|845|
|||_______|_______|
|||314,915|326,114|
|||=======|=======|



The costs of employees were shared with The British Association of Plastic, Reconstructive and Aesthetic Surgeons until 31 March 2021 and the two charitable companies also used to share the secretariat and its related office space. 

With effect from 1 April 2021, the Society operates its own separate and independent secretariat. 

No employee received total emoluments in excess of £60,000 during the current or previous year. The total amount of employee benefits received by key management personnel for their services to the charitable company amounted to £77,000 (2020/2021: £108,356) and the charitable company incurred employer’s national insurance contribution costs of a further £4,634 (2020/2021: £10,315) in relation to the employment of these same members of staff. 

No Council member received any remuneration for services as a Council member provided to the Society during the current or previous year. 

The charitable company has taken out an insurance policy that provides professional indemnity cover for the trustees. This policy provides cover of up to £5 million in respect of any one claim, and the cost of this insurance for the year was £4,257 (2020/2021: £3,229). 

## **Contribution of volunteers** 

In addition to the trustees, the charitable company is also reliant upon the contributions made by other members who contribute significant amounts of their time in the delivery of charitable activities. The trustees are unable to estimate the contribution of volunteers in any meaningful or consistent manner, but they are grateful for the support that members continue to provide. 



**Page 31** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **NOTES TO THE FINANCIAL STATEMENTS** (Continued) **for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

|7.|**INVESTMENTS**|**2022**|**2021**|
|---|---|---|---|
|||£|£|
||Investment listed on a recognised stock exchange, held primarily|||
||to provide an investment return, at market value:|||
||1 June 2021|2,333,098|2,139,480|
||Purchase cost|-|56|
||Proceeds from disposals|-|(60,010)|
||Realised gains|-|12,976|
||Unrealised (loss)/gain|(49,225)|240,596|
|||________|________|
|||2,283,873|2,333,098|
||Cash held by the investment managers|19,247|18,859|
|||________|________|
||31 May 2022|2,303,120|2,351,957|
|||========|========|
||At the balance sheet date, the market value of the portfolio comprised|||
||UK investments in unit trust funds as follows:|||
||Sarasin Endowments Multi-Asset Fund accumulation units|1,166,325|1,201,414|
||SUTL Cazenove Charity Multi-Asset Fund accumulation units|1,117,548|1,131,684|
|||________|________|
|||2,283,873|2,333,098|
|||========|========|



At the balance sheet date, the historical cost of the investments was £1,711,091 (31 May 2021: £1,711,091). 

## 8. 

|**DEBTORS**|**2022**|**2021**|
|---|---|---|
||£|£|
|Amounts falling due within one year:|||
|Trade debtors|56|10,214|
|Other debtors|664|664|
|Prepayments and accrued income|139,213|141,249|
||_______|_______|
||139,933|152,127|
||=======|=======|





**Page 32** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **NOTES TO THE FINANCIAL STATEMENTS** (Continued) **for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

|9.|**CREDITORS**||||**2022**|**2021**|
|---|---|---|---|---|---|---|
||||||£|£|
||Amounts falling due within one year:||||||
||Trade creditors||||13,928|22,290|
||Other creditors||||4,452|-|
||Other taxation and social security||||5,254|18,275|
||Accruals||||17,752|77,860|
||Deferred income – Meetings, courses and events||||25,435|250|
||Deferred income – Journal income||||157,933|218,657|
||||||________|________|
||||||224,754|337,332|
||||||========|========|
||Deferred income reconciliation:||||||
||As at 1 June||||218,907|260,479|
||Released to income||||(218,907)|(260,479)|
||Received in advance during the year||||183,368|218,907|
||||||________|________|
||As at 31 May||||183,368|218,907|
||||||========|========|
|10.|**FINANCIAL INSTRUMENTS**||||**2022**|**2021**|
||||||£|£|
||Carrying amount of financial assets|measured at fair value:|||||
||Equity instruments||||2,283,873|2,333,098|
||||||=========|=========|
|11.|**THE FUNDS OF THE CHARITY**||||||
|||**1 June**|||**Losses on**|**31 May**|
|||**2021**|**Income**|**Expenditure**|**investments**|**2022**|
|||£|£|£|£|£|
||**Unrestricted income funds:**||||||
||General fund|2,480,766|855,555|(967,076)|<br>(49,225)|2,320,020|
|||________|________|________|_______|________|
|||2,480,766|855,555|(967,076)|<br>(49,225)|2,320,020|
|||========|========|========|=======|========|
|||**1 June**|||**Gains on**|**31 May**|
|||**2020**|**Income**|**Expenditure**|**investments**|**2021**|
|||£|£|£|£|£|
||**Unrestricted income funds:**||||||
||General fund|2,187,821|904,249|(864,877)|<br>253,573|2,480,766|
|||________|________|________|_______|________|
|||2,187,821|904,249|(864,877)|<br>253,573|2,480,766|
|||========|========|========|=======|========|



Included within the General Fund are net unrealised gains arising on the revaluation of investments totalling £572,782 (31 May 2021: £622,007). 



**Page 33** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **NOTES TO THE FINANCIAL STATEMENTS** (Continued) **for the year ended 31 May 2022** 

___________________________________________________________________________________________ 

|12.|**RECONCILIATION OF NET (EXPENDITURE)/INCOME TO NET CASH**|**2022**|**2021**|
|---|---|---|---|
||**FLOW FROM OPERATING ACTIVITIES**|£|£|
||**NET (EXPENDITURE)/INCOME FOR THE REPORTING PERIOD**|(160,746)|292,945|
||Adjustments for:|||
||Losses/(gains) on investments|49,225|(253,572)|
||Dividends, interest and rents from investments|(86,122)|(113,648)|
||Decrease/(increase) in debtors|12,194|(74,352)|
||Decrease in creditors|(112,578)|(63,509)|
|||_______|_______|
||**NET CASH USED IN OPERATING ACTIVITIES**|(298,027)|(212,136)|
|||=======|=======|
|13.|**ANALYSIS OF CASH AND CASH EQUIVALENTS**|**2022**|**2021**|
|||£|£|
||Cash held by investment managers|19,247|18,859|
||Cash at bank and in hand|101,721|314,014|
|||_______|_______|
|||120,968|332,873|
|||=======|=======|



## 14. **PENSION COMMITMENTS** 

The charitable company is a participating employer in a centralised defined benefit scheme known as the Superannuation Arrangements of the University of London (“SAUL”) for all qualified employees with the assets held in separate trustee-administered funds. It is not possible to identify the charitable company’s share of the underlying assets and liabilities of SAUL. Therefore, contributions are accounted for as if SAUL were a defined contribution scheme and pension costs are based on the amounts actually paid (cash amounts). The amount charged to the statement of financial activities, included within unrestricted funds, in respect of pension costs (as shown in note 6) is the total contributions payable for the year. Any contributions payable at the balance sheet date are treated as creditors (as shown in note 9). At the year end, unpaid contributions totalled £4,452 (31 May 2021: £Nil). 

SAUL is subject to triennial valuation by professionally qualified and independent actuaries. The last available valuation was carried out as at 31 March 2020 using the projected unit credit method in which the actuarial liability makes allowance for projected earnings. The main assumptions used to assess the technical provisions were: 

|Pre-retirement discount rate|Full gilt yield curve less 0.3% p.a.|
|---|---|
|Post-retirement discount rate|Full gilt yield curve|
|General salary increases|CPI plus 1%|
|Price inflation – RPI|2.70% per annum|
|Price inflation – CPI|1.70% per annum|
|Pension increases in payment|CPI max 2.5% p.a.|





**Page 34** 

## **THE BRITISH SOCIETY FOR SURGERY OF THE HAND** 

## **NOTES TO THE FINANCIAL STATEMENTS** (Continued) **for the year ended 31 May 2022** 

## 14. **PENSION COMMITMENTS** (Continued) 

The actuarial valuation applies to SAUL as a whole and does not identify surpluses or deficits applicable to individual employers. As a whole, the market value of SAUL’s assets was £3,612 million representing 94% of the liability for benefits after allowing for expected future increases in salaries. 

Based on the strength of the employer covenant and the trustee’s long-term investment strategy, the trustees agreed to maintain member contributions at 6% of salaries. Employer contributions will remain at 16% of salaries until 31 March 2022, before increasing to 19% from 1 April 2022 to 31 December 2022, and then further increasing to 21% from 1 January 2023. 

There will also be the introduction of a defined contribution feeder scheme in 2023 for new employees. This will be for the first three years of their employment, with employer contributions of 16%, before being entitled to join the SAUL CARE scheme above. 

The above rates will be reviewed when the results of the next formal valuation (as at 31 March 2023) are known.