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** 

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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: 

- To optimise treatments and outcomes for patients with hand related pathology or injury; 

- To promote the prevention of hand related injuries and pathologies; 

- To disseminate the knowledge of Hand Surgery among members of the Society, the Medical Profession and the general public. 

## **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 

- Disseminating knowledge at scientific meetings and instructional courses 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. 

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** 

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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** 

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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: 

- 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 

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

- • Impact and reach of PR campaigns 

## **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** 

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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,  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 lay persons for a three-year period to attend Council and committee meetings thereby helping to inform the trustees directly on public benefit. The Society also appoints a Public and Patient Initiative Lead and has created network of patients interested in becoming involved in Society projects to develop this further. 

- 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 training opportunities for 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 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 up to two students during their 6-8 week elective period. 

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



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

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

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- 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. 

- Poster prizes of £250 and Paper prizes of £500 are awarded for the best poster and paper 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. 

- The BSSH International Travelling Fellowship provides a total of £10,000 to enable 3 international surgeons to visit UK hand surgery centres of excellence. 

- 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 £1,000 for each hand TIG fellow to attend BSSH, FESSH or IFSSH organised meetings (up to £10,000). 

- The BSSH sponsors up to two places for BSSH members on the British Orthopaedic Association’s Future Leaders Course 

- 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. 

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** 

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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** 

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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** 

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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: 

- 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. 

- Increased collaboration with BAHT 

- Funding of places at the Nottingham University Systematic Review course for 5 people 



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

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

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## **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: 

- Ethiopia project and microsurgery course (collaborating with BFIRST) 

- Providing educational material for the IFSSH global hand education online resource 

- COSECSA WALANT course in Mombasa 

- BSSH BFIRST webinar series 

- A close working relationship with the British Association of hand Therapists (BAHT) 



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

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

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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: 

- Set up Buffer, a social media management software combining the management of all social media accounts 

- Developed the BSSH social media strategy 

- Created a new social media calendar 

- Improved social media output and content 

- Exploring the role of video platforms i.e. TikTok for patient education and professional engagement 

- Established permanent communications links with each Committee to improve links and agility of message dissemination 

- BSSH new logo project 

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

- Improved internal communications via bulletin and website information 

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** 

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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: 

- The EDI Lead is an active member of the BSSH Council and is asked for input on appropriate projects. 

- An EDI resource page has been published on the BSSH website. 

- An EDI session was presented EDI session at the Autumn 2022 scientific meeting in Winchester with the aim of encouraging greater membership involvement in discussion of the Society’s EDI strategy. 

- A campaign was run in the members bulletin via a series of cartoons highlighting issues surrounding physical contact between colleagues. 

## **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: 

- Improve the visibility of hand surgery as a speciality and promote its importance, as we wish to show case the benefits gained from specialist treatment. 

- Highlight the huge burden that problems affecting the hand place on society, business, patients and their families. 

- Celebrate the charitable work of the BSSH in the UK and abroad. 

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. 



**Page 12** 

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

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

___________________________________________________________________________________________ 

## **Membership Levels** 

- Membership levels increased slightly but remain largely consistent:  There were 871 Members (2021/2022: 858) of which 421 were Fellow Members (2021/2022: 427). 


**----- 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>Total Members Fellow Members<br>New Members By Year<br>60<br>50<br>40<br>30<br>20<br>10<br>0<br>2017 2018 2019 2020 2021 2022 2023<br>Fellow Member Associate Member Affiliate Member<br>International Member Student Member Foundation and Core Trainee<br>Honorary Member Senior Member<br># of Members<br>**----- End of picture text -----**<br>




**Page 13** 

## **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** 

- The Society held its Autumn Scientific meeting in November 2023, Glasgow. 

- The eighth series of Instructional Courses will continue in Manchester with 8.7 Dupuytrens and Paralysis to be held in June 2023 and 8.8 Wrist held in February 2024. 

- The Student and Trainee working group will investigate holding one day educational courses for students and foundation and core trainees in 2024. 

- The Global Partnership Committee plans to reinvigorate its joint Global Partnership awareness day with charity BFIRST. 

- The BSSH will continue to run a series of webinars aimed at surgeons and allied health professionals of all levels. 

## **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 



**Page 15** 

## **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 President**from|
||(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 Secretary**2020-2022 and 2022 - 2025|
|D E Boyce|**Honorary Treasurer**2020-2022 (1stJanuary 2020 - 31stDec 2022)|
|Z Naqui|**Honorary Treasurer**2022 (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. 



**Page 16** 

## **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**<br>Z Naqui<br>R Trickett<br>M David<br>N Fine<br>W Khor<br>C Deutsch<br>G Batten<br>J Ruston<br>K Kulkani<br>L McMorrow|**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>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>I McNab<br>K Owers<br>A De Leo<br>S Mee<br>E Bamford<br>R Baker<br>G Goodwill<br>D Edwards<br>A Jester<br>L Reid<br>E Balabanidou<br>H Wohlgemut|**Audit Committee**<br>J Rodrigues<br>A Lupu<br>T Davis<br>E Reay<br>M Gardiner<br>P Stirling<br>R Wade<br>S Ross<br>T Quick<br>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**<br>D Clark<br>S Ankarath<br>D Riley<br>H Dafydd<br>M Calcagni<br>M Lamyman<br>J McEachan<br>W Lam<br>E Davidson<br>L Sayed|**Committee of Management for the Journal**<br>G E B Giddins<br>D Boyce<br>J Coert<br>D Herren<br>I McNab<br>W Lam<br>Z Naqui|
|---|---|
|**Editorial Board for the Journal**<br>Roberto Adani<br>Torben Bæk Hansen<br>Jeremy Bland<br>Maurizio Calcagni<br>Christian Dumontier<br>Ian Grant<br>Sebastian Gunkel<br>Simon Farnebo<br>James Hopkinson-Woolley<br>Christina Jerosch-Herold<br>Gursel Leblebicioglu<br>Ian Leslie<br>Bo Liu<br>Andrew Logan<br>Shai Luria<br>Clifton Meals<br>Charles Pailthorpe<br>Santosh Rath<br>Susanne Rein<br>Jeremy Rodrigues<br>Janos Rupnik<br>Roberto Sanchez-Rosales<br>David Shewring<br>Andrew Smith<br>Mike Solomons<br>Ryan Trickett<br>Paul Werker<br>Feiran Wu<br>Shu Guo Xing|**Global Partnership Committee**<br>J Jones<br>C Mariathas<br>S Deshmukh<br>R Taha<br>H Abed<br>M Glover<br>F Iwuagwu<br>M Ricks<br>D Warwick<br>S Sarker<br>D Izadi<br>J Stanton<br>M Wood<br>N Jagodzinski<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|
|**Financial Audit and Risk Committee**<br>Z Naqui<br>D Boyce<br>J Hobby<br>G Bourke<br>T Syder<br>R Horton<br>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: 

- 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. 



**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: 

- give a true and fair view of the state of the charitable company’s affairs as at 31 May 2023 and of its incoming resources and application of resources for the year then ended; 

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

- have been prepared in accordance with the requirements of the Companies Act 2006. 

## **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: 

- the information given in the trustees’ report, which includes the directors’ report prepared for the purposes of company law, for the financial year for which the financial statements are prepared is consistent with the financial statements; and 

- the directors’ report included within the trustees’ report has been prepared in accordance with applicable legal requirements. 

## **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: 

- adequate and proper accounting records have not been kept, or returns adequate for our audit have not been received from branches not visited by us; or 

- the financial statements are not in agreement with the accounting records and returns; or 

- certain disclosures of trustees’ remuneration specified by law are not made; or 

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

- the trustees were not entitled to prepare the financial statements in accordance with the small companies regime and take advantage of the small companies’ exemptions in preparing the trustees’ report and from the requirement to prepare a strategic report. 

## **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: 

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

- we identified the laws and regulations applicable to the company through discussions with directors and other management, and from our knowledge and experience; 

- we focused on specific laws and regulations which we considered may have a direct material effect on the financial statements or the operations of the company. 

- we assessed the extent of compliance with the laws and regulations identified above through making enquiries of management and inspecting legal correspondence where applicable; and 

- identified laws and regulations were communicated within the audit team regularly and the team remained alert to instances of non-compliance throughout the audit. 

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

- making enquiries of management as to where they considered there was susceptibility to fraud, their knowledge of actual, suspected and alleged fraud; 

- considering the internal controls in place to mitigate risks of fraud and non-compliance with laws and regulations; and 

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

- performed analytical procedures to identify any unusual or unexpected relationships; 

- tested journal entries to identify unusual transactions; 

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

- investigated the rationale behind significant or unusual transactions. 

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

- agreeing financial statement disclosures to underlying supporting documentation; 

- reading the minutes of meetings of those charged with governance; 

- enquiring of management as to actual and potential litigation and claims; 

- reviewing relevant correspondence. 

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|
|||=======|=======|





**Page 34** 

## **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)<br>**for the year ended 31 May 2023**|**NOTES TO THE FINANCIAL STATEMENTS**(Continued)<br>**for the year ended 31 May 2023**|**NOTES TO THE FINANCIAL STATEMENTS**(Continued)<br>**for the year ended 31 May 2023**|**NOTES TO THE FINANCIAL STATEMENTS**(Continued)<br>**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|
|||========|========|





**Page 35** 

## **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|
|||=======|=======|





**Page 36** 

## **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). 



**Page 37** 

## **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)<br>**for the year ended 31 May 2023**|**NOTES TO THE FINANCIAL STATEMENTS**(Continued)<br>**for the year ended 31 May 2023**|**NOTES TO THE FINANCIAL STATEMENTS**(Continued)<br>**for the year ended 31 May 2023**|**NOTES TO THE FINANCIAL STATEMENTS**(Continued)<br>**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|
|||=========|=========|





**Page 38** 

## **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)|<br>(129,579)|(73,710)|2,095,218|
|**Restricted income**|||||||
|**funds:**|||||||
|Lion project|-|101,089|(137,734)|<br>-|36,645|-|
|IFSSH Fellows|-|57,619|(94,684)|<br>-|37,065|-|
||________|________|________|_______|________|________|
||2,320,020|1,214,525|(1,309,748)|<br>(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)|<br>(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|
||========|========|=======|========|





**Page 39** 

## **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|
||=======|=======|





**Page 40** 

## **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.