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2023-05-31-accounts

Company Number: 01213983 Charity Number: 268396

THE BRITISH SOCIETY FOR SURGERY OF THE HAND

ANNUAL REPORT AND AUDITED FINANCIAL STATEMENTS

31 MAY 2023

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

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT

for the year ended 31 May 2023

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 2023.

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 objects for which the Society is established are for the public benefit, to promote and direct development of hand surgery and to foster and co-ordinate education, study and research in hand surgery, including:

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:

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.

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.

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

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.

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.

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

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.

Indicators, milestones and benchmarks

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

Public benefit

The trustees have taken The Charity Commission’s general guidance on public benefit (contained within the “Charities and Public Benefit” publication) 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.

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

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:

Grant making policy

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

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

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.

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 BSSH has also continued to build relationships and networks internationally hosting the triennial International Federation of Societies for Surgery of the Hand (IFSSH) congress in London in June 2022.

Representation on other bodies

The Society is a Principal Member Organisation 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 (BOA) and BAPRAS Council.

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

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.

ACHIEVEMENTS AND PERFORMANCE

Activities and events 1 June 2022 – 31 May 2023

Events

The combined IFSSH, IFSHT and FESSH conference took place at the ExCeL Conference Centre in London from 6 - 10[th] June 2022. The event attracted 3701 registrations compromised of 3069 face-to-face and 632 online delegates from 89 countries. The BSSH also hosted 30 individuals from 18 countries to undertake a fellowship at 18 UK hand surgery centres of excellence. Across the 5 days, there were a total of 1700 presentations and 960 free papers. Online sessions presented and discussed highlights from the programme for those in countries unable to attend face to face due to ongoing COVID-19 restrictions. The Swanson lecture was given by Professor Tim Davis and featured his work on scaphoid fractures. The Presidential lecture was given by Professor Gus McGrouther and discussed current concepts on hand infection. Dr David Ring gave the BSSH Douglas Lamb Lecture on the influence of psychological factors on outcomes in hand surgery. A series of Instructional Course lectures were held focusing on Tendon Disorders of the Hand and Wrist. The lectures were accompanied by a book edited by Messrs. David Shewring, Dean Boyce and Grey Giddins. The textbook was included within the registration fee and will provide a useful resource for years to come.

Course five in series eight of the Instructional Course in Hand Surgery (ICHS) was held on 9-10 September 2022. This event attracted one sponsor. There were 85 paying participants to the event, 78 doctors and 7 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 119 LMIC delegates. The course also attracted 53 delegates who paid a smaller registration fee for post event videos.

Course six in series eight was held on 3-4 February 2023. This event had three sponsors. There were 90 paying participants, 80 doctors and 10 therapists. 81 LMIC delegates were able to attend the course for free. 65 delegates purchased the videos available post event.

Attendance figures for the Instructional Course have declined slightly, the course used to attract 100 delegates or more. The Trustees note that attendance at the Instructional Courses can vary considerably depending on the topic. The Instructional Course Organising Committee plan to address this by reviewing the course structure and venue.

The Autumn Scientific meeting was held at the Guildhall in Winchester on 12-14 October 2022. 21 papers were presented at this meeting. 9 poster infographics were made available at the venue and online. The Harold Bolton lecture was delivered by Professor Stephen Hodgson and The Douglas Lamb lecture was delivered by Professor Kevin Chung. The meeting also included guest lecturer Professor Stephen Hovius. There were 305 participants, 136 consultant members, 81 associate members, 7 honorary members and 81 non-members. There were sixteen sponsors for this event.

The Spring scientific meeting was held at the Swansea Arena in Swansea on 19-21 April 2023. 33 papers were presented at this meeting. 14 poster infographics were made available at the venue and online. Professor Jin Bo Tang delivered the newly introduced BSSH Pioneers lecture (replacing the Douglas Lamb lecture). The meeting included guest lecturers Professor M Tonkin, Professor S Hovius and Dr C Leclercq. There were 317 participants,

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

176 consultant members, 72 associate members, 5 honorary members and 64 non-members. There were eighteen sponsors for this event.

The BSSH have taken a new initiative since COVID pandemic to offer webinars to diversify its educational offering. The following webinars were run during this period:

WEBINAR DATE ATTENDEES
BSSH/BFIRST Global webinar series
Burn injuries of the hand 17th Sep2022 214
Congenital hand surgery 29th Oct 2022 96
Replantation 3rd Dec 2022 174
Carpal injuries 28th Jan 2023 133
Hand infections - Malawi 27th May2023 31
JHSEur Journal Club
Journal Club - September 2022 28thSep2022 81
Journal Club - December 2022 7thDec 2022 104
Journal Club - February2023 22ndFeb 2023 84
STASH Webinars(aimed at students and core and foundationyear trainees)
What is hand surgery? 8th Dec 2023 16
Microsurgeryin hands 12th Jan 2023 44
Hand surgeryand sports 9th Mar 2023 45
Surgical management of congenital hand conditions 25th May2023 27
BSSH/BFIRST Global Trainees Journal Club
BSSH/BFIRST Global Trainees Journal Club - Dec 22 13th Dec 2022 16

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, 441 full length articles, 54 review articles and 137 short reports and letters were published from 632 submissions. The journal twitter account continues to promote important issues instantly.

The impact factor for the journal during this period was 2.206 and the 2023 impact factor is 1.8. Journal sales have been relatively stable overall for the period 1 June 2022 – 31 May 2023.

Hand Diploma and Masters Committee

The Postgraduate Diploma in Hand Surgery programme began in September 2006 and since then 306 candidates have enrolled on the programme. 14 candidates sat the exam in November 2022. 65 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 29 candidates enrolling in 22/23. There is a well refined bank of written questions and skill stations for the examinations. Much interest has been generated from other specialties who would like to benchmark the programme and there has been interest internationally.

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

The Masters programme has 3 students enrolled. 2 dissertations were submitted in 2023. 1 MSc was awarded in 2023. 1 dissertation is due for resubmission and another for submission in September 2023. The committee and examiners ran one exam in November 2022. The new venue, changed the previous year, was used again as it had proved popular with examiners and candidates and was cost effective.

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 Education and Training committee granted eight Education and Travel Bursaries, nine Medical Student Elective Bursaries and two Educational Grants.

The Pulvertaft Prize was awarded for an essay entitled ‘Lessons from the pandemic for hand surgery - what have we learned, and what changes will we see going forward.’

Over the year, the Committee continued to sustain the BSSH Mentoring Scheme providing free professional mentoring training for consultant hand surgeons. Links were again set up between the trained mentors and newly appointed BSSH surgeons who requested a mentor. The scheme was successfully widened to include post-CCT and TIG hand fellows, plus early years consultants (within 5 years of appointment).

The Committee continued to update the patient information leaflets available on the website increasing their accessibility and achieved the standard to allow the Patient Information Forum (PIF) tick to be used for the information provided.

The Committee have also been continuing their research into developing a course for allied health professionals on aspects of hand surgery, along with working on a collaboration to provide a website focusing on the use of wide awake local anaesthesia no tourniquet (WALANT) in surgery.

Research Committee

The Research Committee has awarded two research grants in 2022/2023. Promoting research in Non-invasive electrical stimulation to augment peripheral nerve regeneration and Improving scaphoid fracture diagnosis using artificial intelligence (scAIphoid). Funding was then awarded from the NIHR to the latter, meaning the return of the funds to BSSH.

Two awards were made for Pump Priming to support projects in NECTAR (Neurofilament Light chain Evaluation of Carpal Tunnel Syndrome Before and After Surgical Release) and Developing Preference-based Outcome Measures for Meaningful Health Economic Analyses in Hand Surgery.

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

The committee has also been actively involved in the following:

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

Trauma Committee

The Committee has worked on the publication of Scaphoid standards as well as a scheduled review of its Open and Closed Fracture standards. The Committee also now develop a NHS Getting It Right First Time (GIRFT) style pathway to supplement its standards.

The Committee remain involved with the first and second iterations of the Quality Improvement Project “ HandsFirst Collaborative” with the Royal College of Surgeons of England. 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.

Clinical Data and Registries Committee

In 2023, the name of The Audit Committee was officially changed to the Clinical Data and Registries Committee. This Committee oversees the BSSH UK Hand Registry which was launched in 2012. The BSSH UK Hand Registry is a web based hand surgery audit tool, which allow surgeons to audit their hand procedures with minimal effort. The Committee continue to work towards including further improvements to the UK Hand Registry. In early 2023, a digital badging scheme was introduced where certified UKHR individual users and their Trusts can display a Hand Registry Digital User badge on their digital platforms.

As of 31[st] May 2023, there were 148 consultants and 81 trainees signed up to use the UK hand registry to audit their surgical outcomes. The database currently holds patients’ scores for 18,550 procedures, increasing at an average rate of 1.1% per month.

Going forward, the Clinical Data and Registries Committee will be highlighting the important issue of medical device regulations to the BSSH members.

Patient and Public Initiative (PPI)

The PPI has been enhanced this year with the creation of a network of patients interested in supporting BSSH work.

Global Partnership Committee

The committee has revised its name from Overseas Committee to Global Partnership Committee to reflect the collaborative nature of its work.

The year has focussed on virtual Multi-Disciplinary Team support and maintenance of the relationships with global partners but a number of scoping visits have taken place to Ethiopia, Sierra Leone and Nepal reestablishing more face-to-face links following the pandemic.

A strong emphasis has been placed upon collaboration, highlighted by the following activities:

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

The BSSH & Lilongwe Institute of Orthopaedics and Neurosurgery (LION) project has commenced in Malawi, Africa, with continuous on-the-ground presence by volunteer BSSH consultant and trainee surgeons BAHT therapists since January 2023. For five years, BSSH and BAHT volunteers will assist LION in the delivery of treatment for elective and traumatic conditions of the hand. They will collaborate with local staff in the running of specialist hand clinics and regular hand trauma and elective lists, while promoting sustainability through education and training. LION aspires to become self-sufficient in the provision of specialist hand services by the end of the project.

The Global Partnership Trainee Committee has continued to support many aspects of the main committee’s work. Additionally, they spearheaded the creation of an overseas themed podcast and collaborated with NOTAA and HGOC to host an online research methodology course for WACS trainees. The Trainees trialled a BSSH/BFIRST Global Trainee Journal Club with two webinars, however, due to resources and small delegates numbers, it will not be continued.

The Communications Committee

The Communications Committee has worked on the following projects during the period 1 June 2022 – 31 May 2023:

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. All platforms continue to grow in both size and engagement except Facebook which reflects a lessening of the Facebook SoMe “market share”. Website visits via Twitter and LinkedIn have increased by over 14% this year showing the increase in engagement from social media.

Buffer has enabled the management of all social media channels in one place and will significantly improve reporting engagement going forward.

Social media statistics:

ACCOUNT FOLLOWERS
2022 2023
Twitter < 5,000 5,562
Instagram 2,253 2,655
LinkedIn < 600 964
Facebook 242 282
YouTube < 1,000 1,440

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

The Society continues to produce bi-monthly member e-bulletins with positive engagement from the membership. This year has seen an increase in open rates by 24.5% (50.6% to 63.1%) and clicks on links by 25% (5.6% to 7%).

The number of visits to the Society's website remains high but has slightly decreased from the same period last year to 200,197 visits (4.8% decrease). 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) most are first‐time visitors landing on patient information pages. Apart from the homepage, the 14 most visited pages are patient information. This confirms the importance of the ongoing update of patient information resources.

Standalone projects

Cranfield Trust

The Society again engaged with the Cranfield Trust (a charity providing pro bono services and free resources for other charities) to undertake a review of its financial and business planning processes. The ultimate result of this project was a decision by BSSH Council to stop outsourcing the BSSH finance function and to bring it back in house by employing a member of staff to undertake the work directly. This will result in both cost and efficiency savings for the Society. The Society has also worked with the Cranfield Trust to review and develop its 5 year strategic plan and will survey members and hold a consultation event with them in November 2023.

Equity Diversity and Inclusion (EDI)

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

Hands Re:Worked

The crowdfunded coffee table style book of photographs and inspirational stories from hand surgery patients showcasing the work of BSSH surgeons was published in October 2022. The aim of the book is to:

Sales of the book support the BSSH project to set up a hand unit at the LION unit in Malawi.

Review of Constitution

The Society finalised a review of its governing document. The proposed change to the Society objects were approved by the charity Commission and reworded to put patients at the centre of its charitable aims. The membership categories were also reviewed to be more inclusive, resulting in the widening of Consultant membership to SAS level doctors and the creation of two new categories: student and core and foundation.

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

Membership Levels

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BSSH Membership
1000
900
800
700
600
500
400
300
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100
0
Total Members Fellow Members
New Members By Year
60
50
40
30
20
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2017 2018 2019 2020 2021 2022 2023
Fellow Member Associate Member Affiliate Member
International Member Student Member Foundation and Core Trainee
Honorary Member Senior Member
# of Members
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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

FINANCIAL REVIEW

Financial results of activities and events

During the year, the Society generated £1,214,525 (2021/2022: £855,555) of income and incurred expenditure of £1,309,748 (2021/2022: £967,076) 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 decreased from the prior year to £189,483 (2021/2022: £199,414). Journal income increased by £90,968 (2021/2022: decreased by £94,446). Income from meetings, courses and events increased to £237,546 (2021/2022: £113,719).

After grant giving, an overall deficit of £95,223 (2021/2022: £111,521) resulted for the year, before taking gains and losses on investment assets into consideration. The performance of the Society’s investments in 2022/2023 was acceptable in the current economic environment but did result in an overall decrease in value of £129,579 (2021/2022: £49,255). At the balance sheet date, the charitable company had net current assets of £133,690 (31 May 2022: £16,900), and overall net assets of £2,095,218 (31 May 2022: £2,320,020).

Grant making

Grants, awards and prizes totalling £77,775 (2021/2022: £133,180) 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:

subcommittees and Council. Grants for 2021/2022 comprised the following:
£
Stack Fellowship 12,000
Education and Travel Bursary 16,300
Research Support Grants (refund) (14,077)
Pump Priming 20,625
Joint RCS and BAPRAS Surgical Champion 15,000
Clinical Leaders Programme (BOA) 5,800
Educational grants 11,980
Medical Student Elective Bursaries 4,000
Joint BSSH/Scar Free Foundation Medical Elective Awards 533
Pulvertaft Prize 1,500
Educational Presentation Prize 1,500
Other grants, prizes and awards 2614
_
77,775
=======

Reserves policy

At 31 May 2023, the charity held ‘free reserves’ of £2,095,218 (31 May 2022: £2,320,020).

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.

Page 14 THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

Investments policy continued

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 2023, the charity’s investment portfolio had a market value of £1,941,299 (31 May 2022: £2,283,873), and during 2022/2023, generated investment income of £72,067 (2021/2022: £86,051). For the year ended 31 May 2023, the charity’s investments portfolio fell in value by 14.8% (2021/2022: increased in value by 2.1%), and achieved an average gross income return of 3.71% (2021/2022: 3.76%) and an average net income return (after investment management costs) of 2.89% (2021/2022: 3.3%).

The charity’s cash deposits achieved an average income return of 1.04% (2021/2022: 0.4%).

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. Aware that the charity has been operating at a deficit, a Financial Audit and Risk Committee was created in November 2022 to focus on this issue alongside other finance, governance, staffing and risk related matters. The committee is comprised of the Honorary Treasurer, President, Vice President, Lay Council Representative and Head of Secretariat as well as a Lay Financial Representative with skills in this area. Since the committee's inception, the Trustees have subsequently undertaken to bring the finance function of the BSSH back in house, creating a financial saving. They will also undertake a review of the accounting structure, forecasting and budgeting procedures as well as simplifying the presentation of the management accounts. Corporate sponsorship packages and registration fees for events as well as membership subscription fees will also be reviewed.

PLANS FOR FUTURE PERIODS

Review of Society strategic direction

During the year, the Society has made plans to review its Strategic direction and priorities. The Committees have been asked to undertake a review and prioritise their portfolio of projects. Following this the BSSH undertakes to consult with members via a survey and face to face event before drawing up the draft strategic plan.

Events

Impact of future activities and events

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

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

It is the trustees’ aim that membership levels should not fall significantly below the current levels of 871. This compares to 2021/2022 when there were 858 members. It is hoped the widening of the membership categories adopted with the constitutional review will increase these numbers.

In addition, the number of delegates attending the autumn and Spring Meetings should not fall significantly below the most recent levels of 250-300.

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 2022, as follows:

D E Boyce President(from 1stJanuary 2023),Vice President(until 31stDecember 2022)
J L Hobby President(from 1stJanuary 2022 - 31stDecember 2023).Immediate Past Presidentfrom
(1stJanuary 2023)
G Bourke Vice President(from 1stJanuary 2023)
C Heras Palou Vice President Elect(from 1stJanuary 2023)
S Fullilove Immediate Past President(until 31 December 2022)
I S H McNab Honorary Secretary & Company Secretary2020-2022 and 2022 - 2025
D E Boyce Honorary Treasurer2020-2022 (1stJanuary 2020 - 31stDec 2022)
Z Naqui Honorary Treasurer2022 (from 1stJanuary 2023)
D Brown 2020-2022 (demitted December 2022)
M Horwitz 2020-2022 (demitted December 2022)
G Smith 2020-2022 (demitted December 2022)
D Clark 2021-2023
A Mishra 2021-2023
L Muir 2021-2023
J McEachan 2022-2024
R Shirley 2022-2024
S Talwalkar 2022-2024
J Jones 2023-2025 (appointed January 2023)
H Dafydd 2023-2025 (appointed January 2023)
F Iwuagwu 2023-2025 (appointed January 2023)

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.

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

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
Auditor: Critchleys Audit LLP, Beaver House, 23-38 Hythe Bridge Street, Oxford OX1 2EP
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)
G E B Giddins Chair of the Committee of Management for the Journal of Hand surgery
(European Volume) (2022 - 2026)
W Lam Editor in Chief of the Journal of Hand Surgery (2022-2025)
M Birks Chair of the Education and Training Committee (2022-2024)
D Furniss Chair of the Research Committee and Scar Free Foundation (2019-2022)
A Karantana Chair of the Research Committee and Scar Free Foundation (2022-2025)
J Rodrigues Chair of the Audit Committee (2020 - 2022)
A Lupu Chair of the Clinical Data and Registries Committee (2022 - 2024) previously
Audit
J Jones Chair of the Overseas Committee (2020 - 2022)
C Mariathas Chair of the Global Partnership Committee (2022 - 2024) previously Overseas
S Tucker Chair Trauma Committee (2019-2022)
J Bedford Chair of Trauma Committee (2022 - 2024)
Z Naqui Chair of the Communications Committee (2020-2022)
R Trickett Chair of the Communications Committee (2022 - 2024)
C Y Ng Chair Interface Committee in Hand Surgery (2021-2023)
G Smith Representative for FESSH and IFSSH(2022-2024)
M David Webmaster

Page 17

THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

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

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 in 2022.

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 Vice President Elect, 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 18

THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

Subcommittees

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

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

Page 19

THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

Instructional Course Organising Committee
D Clark
S Ankarath
D Riley
H Dafydd
M Calcagni
M Lamyman
J McEachan
W Lam
E Davidson
L Sayed		 Committee of Management for the Journal
G E B Giddins
D Boyce
J Coert
D Herren
I McNab
W Lam
Z Naqui
Editorial Board for the Journal
Roberto Adani
Torben Bæk Hansen
Jeremy Bland
Maurizio Calcagni
Christian Dumontier
Ian Grant
Sebastian Gunkel
Simon Farnebo
James Hopkinson-Woolley
Christina Jerosch-Herold
Gursel Leblebicioglu
Ian Leslie
Bo Liu
Andrew Logan
Shai Luria
Clifton Meals
Charles Pailthorpe
Santosh Rath
Susanne Rein
Jeremy Rodrigues
Janos Rupnik
Roberto Sanchez-Rosales
David Shewring
Andrew Smith
Mike Solomons
Ryan Trickett
Paul Werker
Feiran Wu
Shu Guo Xing		 Global Partnership Committee
J Jones
C Mariathas
S Deshmukh
R Taha
H Abed
M Glover
F Iwuagwu
M Ricks
D Warwick
S Sarker
D Izadi
J Stanton
M Wood
N Jagodzinski
T Barabas
P Smith
Overseas Trainee Committee
R Taha
A Gough
H Abed
D Osei-Kuffour
A Vaughan
S Thomson
H Benjamin-Laing
D Bodansky
Financial Audit and Risk Committee
Z Naqui
D Boyce
J Hobby
G Bourke
T Syder
R Horton
I McNab
C Smith

Page 20

THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

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. Votes will be counted for each subspeciality applicant individually, and then having excluded the highest ranked applicant from each subspeciality, 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 nominated are then invited to apply. The President is voted for 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 election.

Applications for Honorary Treasurer are sought from Fellows 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 Fellows 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 Elect and one year as Vice-President. 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.

Page 21

THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

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 £4,677 (2021/2022: £4,257).

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 2022 and there were no high-level risks identified.

All other remaining risks listed on the register are rated low. The medium level risks, whilst being kept under review, were 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.

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

Page 22

THE BRITISH SOCIETY FOR SURGERY OF THE HAND

TRUSTEES’ ANNUAL REPORT (continued) for the year ended 31 May 2023

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.

AUDITOR

In accordance with Section 485 of the Companies Act 2006, a resolution proposing the reappointment of Critchleys Audit LLP as auditor to the charitable company will be put to the Annual General Meeting.

STATEMENT AS TO DISCLOSURE OF INFORMATION TO THE AUDITOR

So far as the trustees are aware, there is no relevant information of which the charitable company’s auditor is unaware. Additionally, the trustees have taken all the steps that they ought to have taken as trustees in order to make them aware of any audit information and to establish that the charitable company’s auditor is aware of that information.

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 16th January 2024 and was signed for and on behalf of the board by:

Honorary Secretary & Company Secretary

Mr I S H McNab

Date: 16th January 2024

Page 23

THE BRITISH SOCIETY FOR THE SURGERY OF THE HAND

INDEPENDENT AUDITOR'S REPORT

TO THE TRUSTEES OF THE BRITISH SOCIETY FOR THE SURGERY OF THE HAND

Opinion

We have audited the financial statements of The British Society for the Surgery of the Hand (‘the charitable company’) for the year ended 31 May 2023 which comprise the statement of financial activities, the balance sheet, the statement of cash flows and notes to the financial statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including FRS 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland (United Kingdom Generally Accepted Accounting Practice).

In our opinion, the financial statements:

Basis for opinion

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

Conclusions relating to going concern

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

Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the charity’s ability to continue as a going concern for a period of at least 12 months from when the financial statements are authorised for issue.

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

Other information

The other information comprises the information included in the annual report, including the trustees’ report, other than the financial statements and our auditor’s report thereon. The trustees are responsible for the other information contained within the annual report. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon.

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

We have nothing to report in this regard.

Page 24

THE BRITISH SOCIETY FOR THE SURGERY OF THE HAND

INDEPENDENT AUDITOR'S REPORT

TO THE TRUSTEES OF THE BRITISH SOCIETY FOR THE SURGERY OF THE HAND

Opinions on other matters prescribed by the Companies Act 2006

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

Matters on which we are required to report by exception

In the light of the knowledge and understanding of the company and its environment obtained in the course of the audit, we have not identified material misstatements in the directors’ report included within the trustees’ report.

We have nothing to report in respect of the following matters in relation to which the Companies Act 2006 requires us to report to you if, in our opinion:

Responsibilities of trustees

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

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

Auditor's responsibilities for the audit of the financial statements

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

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

Page 25

THE BRITISH SOCIETY FOR THE SURGERY OF THE HAND

INDEPENDENT AUDITOR'S REPORT

TO THE TRUSTEES OF THE BRITISH SOCIETY FOR THE SURGERY OF THE HAND

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

We assessed the susceptibility of the company’s financial statements to material misstatement, including obtaining an understanding of how fraud might occur, by:

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

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

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

Material misstatements that arise due to fraud can be harder to detect than those that arise from error as they may involve deliberate concealment or collusion.

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

Page 26

THE BRITISH SOCIETY FOR THE SURGERY OF THE HAND

INDEPENDENT AUDITOR'S REPORT

TO THE TRUSTEES OF THE BRITISH SOCIETY FOR THE SURGERY OF THE HAND

Use of our report

This report is made solely to the charitable company’s members, as a body, in accordance with Chapter 3 of Part 16 of the Companies Act 2006. Our audit work has been undertaken so that we might state to the charitable company’s members those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the charitable company and the charitable company’s members as a body, for our audit work, for this report, or for the opinions we have formed.

Katherine Wilkes FCA (Senior Statutory Auditor) Critchleys Audit LLP, Statutory Auditor

Beaver House 23-38 Hythe Bridge Street Oxford OX1 2EP

Date: 28/02/2024

Page 27

THE BRITISH SOCIETY FOR SURGERY OF THE HAND

STATEMENT OF FINANCIAL ACTIVITIES (including Income and Expenditure Account) for the year ended 31 May 2023

Unrestricted Restricted Total Total
Funds Funds 2023 2022
Notes £ £ £ £
INCOME FROM:
Donations 2 161 158,708 158,869 11,091
Disseminating information on the speciality 3 981,713 - 981,713 758,342
Investments 4 73,943 - 73,943 86,122
_______ _
TOTAL 1,055,817 158,708 1,214,525 855,555
EXPENDITURE ON:
Raising funds
Investment management fees 5 (17,803) - (17,803) (10,047)
Charitable activities
Disseminating information on the speciality 5 (1,059,527) (232,418) (1,291,945) (957,029)
_______ _
TOTAL (1,077,330) (232,418) (1,309,748) (967,076)
Net losses on investments 8 (129,579) - (129,579) (49,225)
_______ _
NET EXPENDITURE (151,092) (73,710) (224,802) (160,746)
Transfers between funds (73,710) 73,710 - -
_______ _
NET MOVEMENT IN FUNDS (224,802) - (224,802) (160,746)
RECONCILIATION OF FUNDS
Total fund balances brought forward
at 1 June 2022 2,320,020 - 2,320,020 2,480,766
________ __
TOTAL FUNDS CARRIED FORWARD
AT 31 MAY 2023 12 2,095,218 - 2,095,218 2,320,020
================================ ========

Page 28

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 Restricted Total Total
Funds Funds 2022 2021
Notes £ £ £ £
INCOME FROM:
Donations 2 11,091 - 11,091 10
Disseminating information on the speciality 3 758,342 - 758,342 790,591
Investments 4 86,122 - 86,122 113,648
_______ _
TOTAL 855,555 - 855,555 904,249
EXPENDITURE ON:
Raising funds
Investment management fees 5 (10,047) - (10,047) (16,901)
Charitable activities
Disseminating information on the speciality 5 (957,029) - (957,029) (847,976)
_______ _
TOTAL (967,076) - (967,076) (864,877)
Net (losses)/gains on investments 8 (49,225) - (49,225) 253,573
_______ _
NET (EXPENDITURE)/INCOME FOR THE YEAR
AND NET MOVEMENT IN FUNDS (160,746) - (160,746) 292,945
RECONCILIATION OF FUNDS
Total fund balances brought forward
at 1 June 2021 2,480,766 - 2,480,766 2,187,821
________ __
TOTAL FUNDS CARRIED FORWARD
AT 31 MAY 2022 11 2,320,020 - 2,320,020 2,480,766
================================ ========

Page 29

THE BRITISH SOCIETY FOR SURGERY OF THE HAND

BALANCE SHEET
as at 31 May 2023 Company Number: 01213983
_____________
2023 2022
Notes £ £
FIXED ASSETS
Investments 8 1,961,528 2,303,120
CURRENT ASSETS
Stock 78,000 -
Debtors 9 105,564 139,933
Cash at bank and in hand 328,803 101,721
_ _
512,367 241,654
LIABILITIES
Creditors: Amounts falling due within one year 10 (378,677) (224,754)
_ _
NET CURRENT ASSETS 133,690 16,900
__ __
TOTAL ASSETS LESS CURRENT LIABILITIES & NET ASSETS 2,095,218 2,320,020
======== ========
THE FUNDS OF THE CHARITY
Unrestricted income funds
General fund 12 2,095,218 2,320,020
__ __
TOTAL CHARITY FUNDS 2,095,218 2,320,020
======== ========

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 27 to 40 were approved by the trustees and authorised for issue on 16[th] January 2024, and are signed on their behalf by

President Mr D E Boyce Date: 16/01/2024

Honorary Treasurer S Z H Naqui Date: 16/01/2024

Page 30

THE BRITISH SOCIETY FOR SURGERY OF THE HAND

STATEMENT OF CASH FLOWS for the year ended 31 May 2023

2023 2022
Notes £ £
CASH FLOWS FROM OPERATING ACTIVITIES:
Net cash used in operating activities 14 (58,874) (298,027)
CASH FLOWS FROM INVESTING ACTIVITIES
Dividends, interest and rents from investments 73,943 86,122
Proceeds from the disposal of investments 212,995 -
_ _
Net cash generated from investing activities 286,938 86,122
_ _
CHANGE IN CASH AND CASH EQUIVALENTS IN THE
REPORTING PERIOD 228,064 (211,905)
Cash and cash equivalents at the beginning of the
reporting period 120,968 332,873
_ _
CASH AND CASH EQUIVALENTS AT THE END OF THE
REPORTING PERIOD 15 349,032 120,968
======= =======

Page 31

THE BRITISH SOCIETY FOR SURGERY OF THE HAND

NOTES TO THE FINANCIAL STATEMENTS for the year ended 31 May 2023

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 32

THE BRITISH SOCIETY FOR SURGERY OF THE HAND

NOTES TO THE FINANCIAL STATEMENTS (Continued) for the year ended 31 May 2023

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.

Stock

Stock is comprised of donated equipment stated at its fair value when received. This equipment is being held for onward donation as part of the Lion Project fund initiative.

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.

Page 33

THE BRITISH SOCIETY FOR SURGERY OF THE HAND

NOTES TO THE FINANCIAL STATEMENTS (Continued) for the year ended 31 May 2023

1. ACCOUNTING POLICIES (Continued)

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.

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. DONATIONS 2023 2022
£ £
Donations in cash 80,869 11,091
Donations of equipment 78,000 -
_ _
158,869 11,091
======= =======

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

NOTES TO THE FINANCIAL STATEMENTS (Continued) for the year ended 31 May 2023

NOTES TO THE FINANCIAL STATEMENTS(Continued)
for the year ended 31 May 2023		 NOTES TO THE FINANCIAL STATEMENTS(Continued)
for the year ended 31 May 2023		 NOTES TO THE FINANCIAL STATEMENTS(Continued)
for the year ended 31 May 2023		 NOTES TO THE FINANCIAL STATEMENTS(Continued)
for the year ended 31 May 2023
_____________
3. INCOME FROM DISSEMINATING 2023 2022
INFORMATION ON THE SPECIALTY £ £
Subscription income from members 189,483 199,414
Journal income 518,553 427,584
Income from meetings, courses and events 237,546 102,628
Hand Diploma income 30,450 28,350
Other income 5,681 366
_ _
981,713 758,342
======= =======
4. INVESTMENTS 2023 2022
£ £
Bank interest receivable on short term cash deposits 1,875 70
Income from investments listed on a recognised stock
exchange in the UK 72,068 86,052
_ _
73,943 86,122
======= =======
5. COSTS OF DISSEMINATING 2023 2022
INFORMATION ON THE SPECIALTY £ £
Direct costs:
Membership costs 34,573 34,033
Journal expenditure 101,916 104,313
Meetings, courses and events expenditure 463,361 196,521
Hand Diploma costs 13,409 16,200
Grants, bursaries and prizes awarded to 32
(2021/2022: 21) individuals 77,775 133,180
Website and public relations costs 5,309 7,842
Other direct costs 19,928 5,515
_ _
716,271 497,604
Support and governance costs (see note 6) 575,674 459,425
__ __
1,291,945 957,029
======== ========

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

NOTES TO THE FINANCIAL STATEMENTS (Continued) for the year ended 31 May 2023

6. SUPPORT & GOVERNANCE COSTS Support Governance Total Total
costs costs 2023 2022
£ £ £ £
Staff costs (see note 7)(95:5) 333,132 17,533 350,665 314,915
Premises - operating lease costs_(95:5)_ 13,357 703 14,060 10,172
Office overheads_(95:5)_ 74,372 3,914 78,286 51,142
Legal and professional fees_(95:5)_ 14,774 778 15,552 7,649
Auditor’s remuneration - 9,750 9,750 -
Accountancy costs 45,973 14,928 60,901 55,572
Irrecoverable VAT_(95:5)_ 44,137 2,323 46,460 19,959
Foreign exchange loss (95:5) - - - 16
_______ _
525,745 49,929 575,674 459,425
=============================== =======

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, 11 trustees were reimbursed for travel and subsistence expenses totalling £18,305 (2021/2022: 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).

7. STAFF COSTS 2023 2022
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 267,671 250,687
Social security costs 22,250 17,687
Other pension costs 52,293 38,860
Health insurance costs 4,140 4,091
Other staff costs 4,311 3,590
_ _
350,665 314,915
======= =======

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

NOTES TO THE FINANCIAL STATEMENTS (Continued) for the year ended 31 May 2023

7. STAFF COSTS (Continued)

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 £83,840 (2021/2022: £77,000) and the charitable company incurred employer’s national insurance contribution costs of a further £9,374 (2021/2022: £8,290) 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 £4,677 (2021/2022: £4,257).

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.

8. INVESTMENTS

INVESTMENTS 2023 2022
£ £
Investment listed on a recognised stock exchange, held primarily
to provide an investment return, at market value:
1 June 2022 2,283,873 2,333,098
Proceeds from disposals (212,995) -
Realised loss (19,416) -
Unrealised loss (110,163) (49,225)
__ __
1,941,299 2,283,873
Cash held by the investment managers 20,229 19,247
__ __
31 May 2023 1,961,528 2,303,120
======== ========
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 899,331 1,166,325
SUTL Cazenove Charity Multi-Asset Fund accumulation units 1,041,968 1,117,548
__ __
1,941,299 2,283,873
======== ========

At the balance sheet date, the historical cost of the investments was £1,533,831 (31 May 2022: £1,711,091).

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

NOTES TO THE FINANCIAL STATEMENTS (Continued) for the year ended 31 May 2023

NOTES TO THE FINANCIAL STATEMENTS(Continued)
for the year ended 31 May 2023		 NOTES TO THE FINANCIAL STATEMENTS(Continued)
for the year ended 31 May 2023		 NOTES TO THE FINANCIAL STATEMENTS(Continued)
for the year ended 31 May 2023		 NOTES TO THE FINANCIAL STATEMENTS(Continued)
for the year ended 31 May 2023
_____________
9. DEBTORS 2023 2022
£ £
Amounts falling due within one year:
Trade debtors 54,937 56
Other debtors 664 664
Prepayments and accrued income 49,963 139,213
_ _
105,564 139,933
======= =======
10. CREDITORS 2023 2022
£ £
Amounts falling due within one year:
Trade creditors 37,602 13,928
Other creditors 6,364 4,452
Other taxation and social security 44,110 5,254
Accruals 32,891 17,752
Deferred income – Meetings, courses and events 25,050 25,435
Deferred income – Journal income 232,660 157,933
__ __
378,677 224,754
======== ========
Deferred income reconciliation:
As at 1 June 183,368 218,907
Released to income (183,368) (218,907)
Received in advance during the year 257,710 183,368
__ __
As at 31 May 257,710 183,368
======== ========
11. FINANCIAL INSTRUMENTS 2023 2022
£ £
Carrying amount of financial assets measured at fair value:
Equity instruments 1,941,299 2,283,873
========= =========

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

NOTES TO THE FINANCIAL STATEMENTS (Continued) for the year ended 31 May 2023

12. THE FUNDS OF THE CHARITY

1 June Losses on 31 May
2022 Income Expenditure investments Transfers 2023
£ £ £ £ £ £
Unrestricted income
funds:
General fund 2,320,020 1,055,817 (1,077,330)
(129,579)		 (73,710) 2,095,218
Restricted income
funds:
Lion project - 101,089 (137,734)
-		 36,645 -
IFSSH Fellows - 57,619 (94,684)
-		 37,065 -
__ __ __ _ __ __
2,320,020 1,214,525 (1,309,748)
(129,579)		 - 2,095,218
======== ======== ======== ======= ======== ========
1 June Losses on 31 May
2021 Income Expenditure investments Transfers 2022
£ £ £ £ £ £
Unrestricted income
funds:
General fund 2,480,766 855,555 (967,076)
(49,225)		 - 2,320,020
======== ======== ======== ======= ======== ========

Included within the General Fund are net unrealised gains arising on the revaluation of investments totalling £462,619 (31 May 2022: £572,782).

The aim of the Lion (Lilongwe Institute of Orthopaedics and Neurosurgery) project is to empower local surgeons and therapists in Malawi to specialise in hands, through education and training. A Hand Service, with regular hand surgery and hand therapy clinics, dedicated theatre lists and protected teaching time, has now been established in the newly opened and bespoke LION facility, thanks to the continuous presence of a rotating team of BSSH/BAHT volunteers. We expect that we will be able to gradually withdraw our presence on the ground over time and that this new Hand Unit will become a sustainable service and continue to help heal the hands of Malawi in the future.

As part of the International Federation of Societies for Surgery of the Hand (IFSSH) triennial Congress at the ExCeL in London in June 2022, the BSSH supported 30 individuals from 18 countries to undertake a fellowship at 18 hand surgery centres of excellence across the UK. The funds received from the Federation of European Societies for Surgery of the Hand (FESSH), IFSSH, BFIRST and in private donations were restricted for use on the accommodation and travel costs of this programme.

13. ANALYSIS OF NET ASSETS BETWEEN FUNDS

Fixed Current Current
assets assets liabilities Total
As at 31 March 2023: £ £ £ £
Unrestricted income funds:
General fund 1,961,528 411,278 (378,677) 1,994,129
__ __ _ __
Net assets 1,961,528 101,089 (378,677) 2,095,218
======== ======== ======= ========

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

NOTES TO THE FINANCIAL STATEMENTS (Continued) for the year ended 31 May 2023

13. ANALYSIS OF NET ASSETS BETWEEN FUNDS (Continued)

Fixed Current Current
assets assets liabilities Total
As at 31 March 2022: £ £ £ £
Unrestricted income funds:
General fund 2,303,120 241,654 (224,754) 2,320,020
__ __ _ __
Net assets 2,303,120 241,654 (224,754) 2,320,020
======== ======== ======= ========
14. RECONCILIATION OF NET EXPENDITURE TO NET CASH 2023 2022
FLOW FROM OPERATING ACTIVITIES £ £
NET EXPENDITURE FOR THE REPORTING PERIOD (224,802) (160,746)
Adjustments for:
Losses on investments 129,579 49,225
Dividends, interest and rents from investments (73,943) (86,122)
Increase in stock (78,000) -
Decrease in debtors 34,369 12,194
Increase/(decrease) in creditors 153,923 (112,578)
_ _
NET CASH USED IN OPERATING ACTIVITIES (58,874) (298,027)
======= =======
15. ANALYSIS OF CASH AND CASH EQUIVALENTS 2023 2022
£ £
Cash held by investment managers 20,229 19,247
Cash at bank and in hand 328,803 101,721
_ _
349,032 120,968
======= =======
16. OPERATING LEASE COMMITMENTS

At the reporting period end date, the charity has outstanding commitments for future minimum lease payments under non-cancellable operating leases which fall due as follows:

2023 2022
£ £
Operating leases which expire:
Within one year 24,684 25,596
Between one and five years - 24,684
_ _
24,684 50,280
======= =======

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THE BRITISH SOCIETY FOR SURGERY OF THE HAND

NOTES TO THE FINANCIAL STATEMENTS (Continued) for the year ended 31 May 2023

17. RELATED PARTY TRANSACTIONS

Donations from related parties totalled £6,000 (2022: £Nil) from a trustee and a charity with a mutual trustee.

18. 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 7) is the total contributions payable for the year. Any contributions payable at the balance sheet date are treated as creditors (as shown in note 10). At the year end, unpaid contributions totalled £6,364 (31 May 2022: £4,452).

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.

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 NTEmaintain 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.