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2021-12-31-accounts

Annual report July 2022

Annual report and financial statements

For the year ended 31 December 2021

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Contents

4 Introduction

8 The year in review 10 Promote healthy lives for all 14 Supporting health care improvement 18 Influencing health and social care policy 22 The sustainability of health and social care funding 26 Data analytics for better health 30 Work to improve the Foundation

35 Our plans ahead 36 Promote healthy lives for all 37 Supporting health care improvement 38 Influencing health and social care policy 39 The sustainability of health and social care funding 40 Data analytics for better health 41 Work to improve the Foundation

42 Financial review and statements

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Improving people’s health

Introduction from the Chief Executive and Chair

Clearly there continued to be significant challenges for health and care in 2021. With the NHS facing unprecedented backlogs, public services under pressure, the nation’s health reeling from the direct and indirect effects of the pandemic, the economy weakened, and turbulence in government, there is a valuable role for foundations in identifying solutions and keeping a focus on the long term. The Health Foundation doesn’t deliver care directly – health care, social care or public health services. So how can we help?

The Health Foundation makes a contribution to improving health and care for the UK population in a number of ways, and working with numerous other organisations. As a foundation we are concerned with immediate challenges and needs – especially in a pandemic. But importantly we also support longer term goals that lay foundations for a better future. Our 2021 annual report shares some of the highlights from our work and looks ahead to our plans for 2022.

In 2021, as in 2020, we were unusually focused on the near term given the pandemic. We continued to make progress through: research and analysis; grants for new centres; large programmes and projects on the ground; building capacity through supporting fellowships and networks, and increasingly using influence as investors via our endowment to make change. As last year, we also gave donations for emergency assistance – donating £2.2m overall in 2021 to Comic Relief, Children in Need, UNICEF UK and Pathway. And all this while working with others to maximise impact.

Our research and analysis remain a central strand of our work, generating robust evidence to influence policy and practice. In 2021, our online traffic continued to increase significantly, with several major outputs allowing us to reach wider audiences and gain media traction. These included analysis on ‘levelling up’ health, the elective care gap, and real-terms cuts to the public health grant and to Universal Credit. The high-profile launch of our COVID-19 impact inquiry provided landmark evidence of the unequal impacts of the pandemic and enabled us to engage policymakers and media on the levelling up agenda. Meanwhile our quantitative analysis has supported SAGE, and funding and staffing projections from the REAL Centre fed into NHS and DHSC discussions in advance of the September

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announcement of health and social care funding, and the Spending Review in October. These pages contain more noteworthy highlights and short case studies highlighting impact within each of our strategic priority areas.

As a foundation, our impact comes also from the projects, programmes and award-winning innovations we fund. Through our Q Exchange programme we funded 30 projects to embed some of the positive changes emerging through new collaborations and partnerships during the pandemic. This included projects to make remote consultations more inclusive and to upskill staff. Other projects included the scaling up of an initiative to provide psychological support for staff, which has been integrated as a core part of the new North Bristol NHS Trust staff trauma support pathway. Also in response to the pandemic, The Healthcare Improvement Studies (THIS) Institute, hosted by the University of Cambridge and funded by the Health Foundation, has adjusted its portfolio to support the NHS. This included leveraging its online research platform, THIScovery, to enable wider contributions to research from service users, NHS staff and others. The Institute also published a practical framework for organisations on asymptomatic COVID-19 testing programmes in their workplaces.

It can take time for the full impact of our funding programmes to become clear. Our funding of a quality improvement intervention to scale up PReCePT2 – aiming to reduce brain injury in new-born babies by improving uptake of magnesium sulphate in preterm deliveries – ran between 2018 and 2020. Results of the trial’s primary and secondary outcome measures were published in May 2021. PReCePT has now been adopted by all 152 maternity units in England and magnesium sulphate uptake has increased to over 85% for eligible mothers. As a result, 48 cases of cerebral palsy were prevented between 2018 and 2021, saving £38.4m in lifetime health and social care costs. (See Case study: Reducing brain injury through PReCePT.)

Closer to home, our internal development programme is continuing to ensure that we have a well-supported workforce, efficient business processes, resilient infrastructure and a strong focus on our role as a modern and socially responsible foundation. 2021 saw us successfully establish hybrid working, responding to staff preferences on office and home working. And, following Board agreement on a responsible investment policy in late 2020, in 2021 all investment managers reported on environmental, social and governance (ESG) credentials for the funds they invest in. ESG is now a major consideration for the investment committee and the Board.

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In 2021 we continued to organise our work through five strategic priority areas to help us respond to the key challenges in health and care for people in the UK. In 2022 we will be looking ahead and refreshing our strategy for the following 3 years. We will be exploring how we deliver better health and health care from 2023–26 within three main areas relevant to our work and mission: improving health and reducing inequalities; faster improvement in care; and better policymaking.

In each area, we have an ambitious and innovative portfolio of work, in-house and externally commissioned. Our impact in 2021 is due to the hard work and commitment of staff, governors and the people we work with across health and care. We are very grateful for their support, in what have continued to be challenging circumstances. We look forward to making progress in 2022 and beyond – always for the benefit of the UK population and, in particular, the most vulnerable in society.

Dr Jennifer Dixon Chief Executive

Sir Hugh Taylor Chair

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2021: Year in review

Promote healthy lives for all

Good health is vital for a thriving country – allowing people to play an active role in their communities and at work.

We have raised awareness of health inequalities and the role that good health plays in supporting economic prosperity. We have influenced national policy commitments to address health inequalities and established the Foundation as a leading authority in this area.

Key highlights

Large-scale grant programmes: This year local authority teams began work on our first large grant programmes to explore the actions places can take to influence the circumstances that shape our health. Shaping Places for Healthier Lives is a joint programme with the Local Government Association and is funding five local partnership teams to change local systems in order to improve physical and mental health. We invested £0.7m in this programme. Secondly, Economies for Healthier Lives has invested £1.9m of grant programme funding in four local authority teams to explore effective ways to incorporate health and wellbeing into local economic strategies.

Taking a whole-government approach to improving

health: Published in October, our briefing argues that concerted and holistic action needs to be taken to create the conditions that improve health. It calls for an ambitious cross-government strategy that places improving health at the heart of the government’s agenda, led by the Prime Minister, with targets, funding and evaluation metrics. This report has provided a robust platform to influence and shape the levelling up agenda and health disparities white paper, working with various government departments.

21 £1.9m

£2.6m

For four local authorities to explore how best to incorporate health into their economic strategies

Events our experts were invited to speak at about healthy lives

Total invested in our programmes Economies for Healthier Lives and Shaping Places for Healthier Lives in 2021

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Launching our evidence hub: What drives health inequalities? brings together data, insight and analysis that highlight how the circumstances in which we live shape our opportunities for healthy lives. Our evidence long reads have been effective in driving engagement: for example, the long read on housing and health has been cited in parliament, featured in several House of Commons debate packs, and in policy documents such as the Scottish government’s Housing 2040 strategy.

Funding work to create impact: Our grant holders from our Social and Economic Value of Health and COVID-19 funding programmes appeared before the Work and Pensions Select Committee. Our young people’s inquiry post holders have also produced impactful reports, been invited to speak at conferences and given advice to government departments.

Recognising our expertise: Our expertise is increasingly sought after, with invitations to sit on eight advisory groups and to speak at 21 events in 2021. This included speaking at events organised by the WHO and OECD. There were also a series of invitations to contribute to the work of other organisations as they develop their work on health and health inequalities.

“The inquiry was ~~mentioned in parliament~~ by Sajid Javid on its launch day, and former health secretary Jeremy Hunt also agreed to meet to discuss the inquiry report.”

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3.7×

In England, COVID-19 mortality rates were 3.7 times higher for people younger than 65 from the most deprived 10% of areas (compared with the least deprived)

Case study Unequal pandemic, fairer recovery

The UK entered the pandemic with life expectancy stalling for the first time in a century and falling for some. Following the 2008 financial crisis, public services have been eroded and the underlying economy and social fabric frayed. Published in July 2021, our COVID-19 impact inquiry reviewed the factors that fuelled the UK’s COVID-19 death toll.

The inquiry found that poor health and existing inequalities left parts of the UK vulnerable to the virus and defined the contours of its devastating impact. The pandemic has revealed stark differences in the health of the working age population – those younger than 65 in the poorest 10% of areas in England were almost four times more likely to die from COVID-19 than those in wealthiest. Our report highlighted that the recovery needs to prioritise creating opportunities for good health – a vital asset needed to 'level up' and rebuild the UK economy.

The inquiry was mentioned in parliament by Sajid Javid on its launch day, and former health secretary Jeremy Hunt also agreed to meet to discuss the inquiry report. The report received a wide range of media pickup – with 55 pieces of coverage including The Guardian , The Times , Sky News , Times Radio , The Independent , and The Scotsman . It was widely shared on social media and via other organisations’ websites, social channels and newsletters. The inquiry team were invited to contribute to a ministerial roundtable on long COVID, and a written submission drawing on the inquiry report was cited multiple times in the Health and Social Care Committee’s Coronavirus: lessons learned to date report.

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Supporting health care improvement

Through our improving care strategic priority we have supported the development and spread of innovative care improvements, while influencing the external environment to shift improvement from the margins of health care into mainstream policy thinking.

Key highlights

Publishing research on technology in health care: During 2021 we published Securing a positive health care technology legacy from COVID-19 , which explored the challenges of implementing health care technologies during the first phase of the pandemic. It achieved high levels of engagement online and was covered by the Mail Online and ITV News. Our research report Switched on looked at harnessing the potential of AI and automation to improve health care, and was covered in The Independent . Following these publications, we were invited to join a research project within the national AI Ethics Initiative on building confidence among NHS staff in using AI. We were also invited to work with NHSX to inform the National Strategy for AI in Health and Social Care.

Building awareness of quality improvement: We published a new edition of our Quality improvement made simple quick guide, which remains one of the Foundation’s most widely read titles. The updated guide reflects recent changes in quality improvement and will be especially useful to anyone thinking about how to restart, re-design or develop new processes, pathways and services – particularly as services recover from COVID-19. We also continued to work with The BMJ to publish a series of articles about quality improvement, including practical advice to health care professionals new to the field.

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4,600

Projects funded through Q Exchange

Support hubs funded through our Adopting Innovation programme

Members of Q

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Supporting innovation in local health systems: We launched a new funding programme, Adopting Innovation, to support promising ideas become practice by developing support hubs across the country. We announced the selection of four hubs – led by the Bradford, Cambridgeshire and Peterborough, Manchester and Dorset integrated care systems.

THIS Institute: In response to the pandemic, The Healthcare Improvement Studies (THIS) Institute, hosted by the University of Cambridge and funded by the Health Foundation, adjusted its portfolio to support the NHS. This included leveraging its online research platform, THIScovery, which aims to enable wider contributions to research by crowdsourcing perspectives from service users, NHS staff and others. For example, the Institute published a practical framework for organisations using asymptomatic COVID-19 testing programmes in their workplaces. Following the success of its work on maternity safety, THIS Institute was also appointed to work in partnership with the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives to deliver the first phase of the Avoiding Brain injuries in Childbirth (ABC) Collaboration.

Q community: We funded 30 projects through our Q Exchange programme on the theme of embedding positive changes emerging through new collaborations or partnerships during COVID-19. The programme included projects to develop remote consultations that are inclusive of non-English speaking communities and to upskill staff to make the most of new technologies. Other projects include scale up of the ‘Start Well>End Well’ procedure to provide psychological support for staff, which has been integrated as a core part of the new North Bristol NHS Trust staff trauma support pathway. We also launched a new Q Lab project with NHSX to explore how to build staff and patient trust and confidence in remote monitoring technologies, to support national scale. The project brings together people with digital expertise and improvement expertise to create sustainable models that make progress on this vital challenge for the system.

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Cases of cerebral palsy were prevented between 2018 and 2021

Case study Reducing brain injury through PReCePT

In the UK, around 60,000 babies are born prematurely each year and are at greater risk of brain damage and conditions such as cerebral palsy, which affects 500 pre-term babies annually. Evidence shows that mothers at risk of premature delivery who take magnesium sulphate during pre-term labour and before birth – at a cost of less than £1 per dose – can reduce the risk of their babies developing cerebral palsy by a third.

From 2014 to 2015, the PReCePT1 project (Prevention of cerebral palsy in pre-term labour) was implemented in five West of England maternity units. During the project, maternity units and mothers co-developed and delivered a quality improvement toolkit with practical tools and training to increase knowledge and awareness of using magnesium sulphate. As a result, the number of women receiving the preventative treatment increased by an average of 25%.

Following this success, NHS England and NHS Improvement rolled PReCePT out nationally through the AHSN Network between 2018 and 2020. As part of this, the Foundation provided additional funding for an enhanced quality improvement intervention, which included bespoke coaching and extra time for local clinical champions.

PReCePT has now been adopted by all 152 maternity units in England and magnesium sulphate uptake has increased to over 85% for eligible mothers. As a result, 48 cases of cerebral palsy were prevented between 2018 and 2021, saving £38.4m in lifetime health and social care costs.

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Influencing health and social care policy 11

We have built constructive relationships with policymakers, influenced national policy and contributed to understanding about health and care policy and performance in England.

This work has proved central to the Foundation’s ability to influence change and inform wider debate, bridging the gap between policy and practice. Much has been done to track and analyse national policies in England, with a particular focus on the overall direction of the health system and how it is performing.

Key highlights

Assessing the impact of COVID-19 on elective care: In April we published Longer waits, missing patients and catching up , looking at the impact of the second wave of the pandemic on elective care in England. While the NHS had delivered a

remarkable amount of elective treatment, the analysis warned the waiting list could still grow substantially depending on how and when 'missing patients' are belatedly added. In September further analysis showed access to elective care falling further in more deprived areas compared with the least deprived.

Learning lessons from government’s social care response: May saw the publication of our second assessment of the national policy response in social care during the pandemic – this time covering the period after the first wave (June 2020 to March 2021). It found that the response had improved in some areas, but government policy on social care was often fragmented and short term. This supported our influencing work on social care reform and will be a key part of our evidence we will share with the UK COVID-19 Inquiry.

140,000[+]

Times that our policy trackers were viewed since launch

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Tracking policy developments: Our NHS Test and Trace (NHSTT) tracker monitored the performance of NHSTT up until May 2021. Meanwhile we launched our COVID-19 policy tracker – an overall timeline of national policy and health system responses to COVID-19 in England during 2020. These tracking tools were used widely by policymakers, the media, academics, and others – and viewed over 140,000 times in total since their launch in 2020.

Developing our public polling work: In January we

published the final wave of polling carried out by Ipsos on public perceptions of the NHS and social care in light of COVID-19. We also co-hosted a webinar with Ipsos How will the public mood shape care after the pandemic? in April. In October, during the lead up to COP26 in Glasgow, we published findings of Ipsos polling on public perceptions of climate change and health. This work produced unique insights that were used by policymakers, covered by a diverse range of media, and informed and enriched our in-house analysis.

The NHS Long Term Plan and COVID-19: In September we published our comprehensive analysis looking at progress on the main pledges in the NHS Long Term Plan in the wake of the pandemic. Our analysis found that the core principles set out in the plan remain as relevant now as ever, but their implementation has been derailed – with no part of the plan unaffected. The report will stand as an authoritative assessment of NHS delivery and how the pandemic blew the plan off course through disruption, delay and increased demand.

“When the bill was published in July, we ~~briefed MPs and Lords~~ on the legislation and how it could be strengthened.”

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Case study Influencing NHS reform

Proposals emerged in late 2020 for changes to the organisation and structure of the NHS in England. We published analysis assessing the initial proposals in The BMJ – drawing on our long history of work on integrated care and approaches to NHS reform – and submitted evidence to national NHS bodies. We set out our views on the risks of reform and how the plans could be improved. While encouraging collaboration to improve health makes sense, we were concerned that the benefits of the proposed changes were overstated and the risks of reorganisation underplayed.

In February 2021, the government’s white paper on the reforms included plans to increase central political control over the day-to-day running of the NHS. We responded to the proposals in the media – setting out the risks of politically motivated changes to the organisation of the NHS – and held a webinar to help people working in health and care understand and assess the reform plans.

We gave evidence to the Health and Social Care Select Committee’s inquiry into government’s reforms. When the bill published in July, we briefed MPs and Lords on the legislation and how it could be strengthened. We also worked with others in the health and care system to try to inform amendments to the legislation including on workforce planning and health inequalities. And we helped shape amendments to legislation related to NHS data collection on health inequalities. In 2022 we will be working to encourage amendments on workforce planning and social care.

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The sustainability of health and social care funding

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Through the REAL Centre we have increased understanding of the requirements for future service sustainability, influenced national policy commitments and helped to hold government to account. We have established the Foundation as leading experts on NHS and social care supply and demand issues.

Key highlights

Exploring a radical new vision for social care: In November, at our second REAL Challenge annual lecture, acclaimed author and social innovator Hilary Cottam reexamined the way we think about social care. The well-attended and lively debate considered how we should care for one another, and what might it take to turn our current thinking about care and the care system on its head.

Analysing how ageing affects health and care need in England: In December we published our insight report, Our ageing population . It explored how health and care needs change with age, how the relationship between need and age has changed over time and how long-term conditions and social care needs interact. The report included five key insights for policymakers, and we successfully used interactive graphics to communicate the findings in a timely and effective way.

1,000[+]

£63bn– £72bn

People attended the REAL Challenge lecture on Hilary Cottam’s radical new vision for social care

Projected as additional annual funding needed for health care in 2030/31 compared with 2018/19

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Setting out health and social care funding projections for the next 10 years: Our research in this area was a huge success for the REAL Centre in 2021. By engaging early with key stakeholders we built credibility and it enabled us to adapt to a rapidly changing external environment. We published on the morning of the government’s NHS funding announcement, which meant we gained widespread coverage (including the FT , The Telegraph and Channel 4). We focused on different areas – funding and workforce – and used multiple outputs to maximise our reach and impact.

Researching changes to the social care cap: During 2021, as government moved towards social care reform, we looked at the social care cap proposals. Our analysis presented different scenarios, highlighting that the value of the cap has the greatest proportionate impact on those with lower levels of wealth. One key chart from the analysis (illustrating the impact of changes to the cap) was used by Sir Andrew Dilnot in evidence to the Treasury Select Committee. It was also widely covered by national media, across the broadsheets and tabloids, aiding public understanding of the issue.

Influencing the Spending Review: REAL Centre analysis contributed significantly to our influencing work, including underpinning three of the four priorities for health that we set out ahead of the Spending Review.

“ Over the summer of 2021, we were then approached by DHSC to help ~~inform their report to SAGE~~ on the direct and indirect health impacts of COVID-19 in England.”

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Case study The impact of the pandemic on non-COVID patients

In 2021 the REAL Centre had a unique opportunity to answer critical questions about the impact of the pandemic on non-COVID patients. This was a continuation of the bespoke analysis about primary care access we provided to the Department of Health and Social Care, NHS England and the Number 10 delivery unit in 2020.

Our research used data not available to government or NHS England on patient-level primary care records. This allowed us to understand the reduction in access to primary care, referral to secondary care, and diagnosis of new (non-COVID) illness for patients of different ages, genders, ethnicities and socioeconomic backgrounds. This information was vital in assessing the implications of the pandemic and informing how to enable NHS recovery.

We were not the only research unit with access this information. However, our research was so impactful because of our ability to adapt, our flexible data permission, our existing links into the Department of Health and Social Care and NHS England, and our willingness to consult with and directly inform policymakers. Instead of publishing via the usual Health Foundation channels, we targeted academic publication (in BMJ Open ) for a specific analysis on the impact of the pandemic on cancer diagnosis.

Over the summer of 2021, we were then approached by DHSC to help inform their report to SAGE on the direct and indirect health impacts of COVID-19 in England. The final analysis resulted in a letter of thanks to the REAL Centre from the Chief Scientific Adviser for DHSC. We have also since been asked to contribute to a further report informing the pandemic recovery, focusing on missing diagnosis of long-term illness in primary care.

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Data analytics for better health 26

In 2021 we continued to generate data-driven insights to help improve understanding and inform decision making about major health and care challenges, including those exacerbated by the COVID-19 pandemic. We’re a trusted voice on national policy and system design issues relating to analytics and data-driven technology, and we’re working to create a future where everyone can benefit from developments in these areas.

Key highlights

Undertaking sophisticated quantitative evaluation:

The Improvement Analytics Unit (IAU) continued to evaluate complex local initiatives to support learning in health care in 2021. In October, the IAU team published research looking at whether integrated care programmes have reduced emergency admissions, sharing important lessons for policymakers and system leaders. Direct engagement with key stakeholders was particularly positive and valuable for this work.

Developing data analytics partnerships for local

insights: Gathering steam in 2021, the Networked Data Lab (NDL) continued its pioneering work on analytics of linked data. We analysed datasets held by NDL partners, this year focusing on exploring the impact of the pandemic on clinically extremely vulnerable people who were advised to shield. The findings supported local stakeholders in prioritising support and services for this group, enabled by the embedded nature and strong local ties of this programme. The briefing we published in October was reported by multiple media outlets, including The BMJ and The Independent , showing strong national interest in this work.

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1,000[+] members

Peer review journal publications and pre-prints across the Foundation

Of the NHS-R Community, funded by the Foundation to promote the use of open-source data tools

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Collaborating on international comparisons of health care

systems: We jointly funded, and produced the English analysis for, the International Collaborative on Costs, Outcomes and Needs in Care (ICCONIC). This work uses patient-level data to advance international comparisons across whole care pathways – which our research shows is essential to improving care for older patients with complex needs, who often require services that cross many settings. The ICCONIC findings provide policymakers with useful information on how different strategies might influence care quality and cost, and offer the potential for mutual learning and policy transfer.

Strengthening social care analytics in the wake of the

pandemic: In 2021 we announced our funding and support for five projects developing innovative analytics to tackle pressing challenges in social care. These projects, which all have a focus on engaging and involving service users, are already demonstrating impact on improving care and are helping to demonstrate the value of data analytics and information sharing in social care.

Helping ensure AI addresses racial and ethnic inequalities

in health: In partnership with the NHS AI Lab, we launched an important new research call in 2021. Projects led by the University of Westminster, Loughborough University, University Hospitals Birmingham NHS Foundation Trust, and St George’s University, London will help address racial and ethnic health inequalities using artificial intelligence. This will be achieved through improving understanding of opportunities to use AI to address health inequalities, optimising datasets, and improving AI development, testing and deployment.

“We launched an important new research call... to address racial and ethnic ~~health inequalities using artifcial intelligence~~ .”

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Case study Taking a longer term view

A key objective of our work over the past 6 years has been to influence national strategy on the use of analytics across the health and care system. Our publications Understanding analytical capability in health care (2016) and Untapped potential: Investing in health and care data analytics (2019) shone a light on the importance of analytical capability and the actions needed to strengthen this. This has built on our investment in exemplar projects in health and social care (Advancing Applied Analytics, Strengthening Social Care Analytics and our Better Care Catalyst partnership with Health Data Research UK), and our support for networks such as AphA, NHS-R and the Welsh Modelling Collaborative.

The impact of this work on national strategy became evident in June 2021, when government published its draft data strategy for health and social care ( Data Saves Lives ). This pledged to implement many of our recommendations – committing to building the profile of the analyst profession, to providing competency frameworks, and to improving understanding of the professional learning and development needs of health and care analysts. Our work on social care data – as part of the NIHR-funded DACHA study – was also recognised as an example of the efforts needed to improve the use of data in adult social care.

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Work to improve the Foundation

Our programme of internal development enables us to deliver our strategy by investing in our people, how we work together, the tools we use, and the space we work in.

2021 was a continuation of a challenging working environment for everyone. By supporting each other, we got through these challenges. We found the time to continue our internal development with some notable achievements.

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Key highlights

People’s wellbeing and flexible working: We engaged colleagues across the organisation on wellbeing and how they wanted to work in the future. We responded by giving everyone working at the Foundation more choice over where and when they work, within a broad framework, based on high trust and high support, with continuing support for our wellbeing. We part re-opened our office for those that needed it, laying the foundations for hybrid working in 2022. We continued to support learning and development and resumed our leadership programme.

Strengthening our cyber and data security: We strengthened our IT networks, achieved cyber security essentials plus accreditation, renewed our information security management system accreditation for our secure data environment (ISO 27001) and started to develop a new platform for analysts. We introduced a compliance team to help raise awareness and train people, which helped us remain compliant with the Data Protection Act 2018.

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Striving to build a more equitable, diverse and inclusive organisation: We delivered the organisation’s first inclusion survey, which identified areas for improvement including: reviewing our internal processes; developing our internal learning and engagement; discussions on the role of the board and linking it to our external-facing work. We also set up an Inclusion Panel so that a range of people with varying lived experiences, knowledge and skills have the opportunity to influence health and social care research.

Embedding environmental sustainability: This has included leveraging our role as a provider of analysis and research, reviewing how we give grants, being a responsible investor, running events and managing our workplace.

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Our plans ahead 35

Promote healthy lives for all

We will be continuing to explore how the circumstances in which we live shape our health.

z[In 2022 we will launch a ] landmark review into health inequalities in Scotland.

z[We will continue our work to ] ensure the whole of government works together to improve health and health equity. And we will outline the evidence-based policy approaches that can be taken to improve health across the whole of the UK.

z[We will be adding new data, ] insight and analysis to our What drives health inequalities? evidence hub, including a new section on neighbourhoods.

z[Local and regional authorities ] have a central role in improving health. Over 2022, we will explore what some of the key factors might be to improve health in a place.

z[We will share materials to ] improve public understanding of and support for wider action to improve health, including findings from the Frameworks Institute.

z[We are also working with a range ] of organisations to strengthen the policy agenda for young people’s future health and to launch an open call to fund research on emotional support.

z[We are working with ShareAction ] to promote positive action on health among businesses and investors.

z[The Collaboration for Wellbeing ] and Health will move into its action phase, recruiting a wider group of cross-sector allies, and launching its first campaign to influence policy and amplify the case for action on the wider determinants of health.

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Supporting health care improvement

Our supporting improvement work aims to influence approaches to system recovery, demonstrate how better management and improvement approaches can improve quality and productivity, and how innovation and technology can enable new models of care.

z[2022 will see continued ] investment in some of our existing initiatives, including the Flow Coaching Academy, the Common Ambition programme and the Health Anchors Learning Network. We will also continue to develop more recent initiatives, including the new IMPACT Centre and our Adopting Innovation programme.

z[We will be launching a funding ] programme to support the use of technology to enable new models of care, particularly those that support more care at home or in the community. We will also undertake new research on this topic, as well as sharing learning through our insight work on learning health systems, NHS management, elective recovery, and the innovation landscape.

z[Expected to reach the milestone ] of 5,000 members in 2022, our Q initiative also has big plans. We are supporting peer-learning for national and regional leaders in improvement, providing support for learning and innovation through Special Interest Groups and our events programme.

z[Q Lab and Q Exchange also have ] exciting work underway, bridging the worlds and methods of improvement and digital (with Q Lab UK looking at what is needed for staff and patient confidence in tech-enabled remote monitoring).

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Influencing health and social care policy

We want to support the development of more evidence-informed policies on health and social care in England, contributing to better population health and higher quality care.

z[We will maintain a focus on ] international comparisons of health system policies and performance, continuing to fund major external programmes in this area, including Sciana, Harkness Fellowships, QualityWatch, and the European Observatory on Health Systems and Policies.

z[Look out for new work ] synthesising evidence on approaches to NHS reform and national policies to reduce inequalities in general practice. We will also be producing analysis on the current reorganisation of the NHS in England, including the development of integrated care systems and the approaches they are developing to improve population health.

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The sustainability of health and social care funding

The REAL Centre (Research and Economic Analysis for the Long term) produces research and analysis to help make health and care services more sustainable, enhancing our understanding of trends in health care supply and demand, and supporting better long-term decision making.

z[Our work on workforce ] projections will look at the outlook for both the demand and supply of health care staff over the next decade. Our work will look in detail at the impact of trends in nursing and general practice. We will also look at health care demand, and will do a deep dive into healthy life expectancy. This is part of the foundational work to develop a comprehensive health care demand model in partnership with the University of Liverpool. The final model will allow us to link risk factors to morbidity and health care activity, providing an improved base for future funding projections reports.

z[With projects from our Efficiency ] Research Programme coming to an end, we’ll be sharing their knowledge and learning on technology and productivity.

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Data analytics for better health

We want to ensure that everybody’s health and care benefits from advances in analytics and data-driven technology such as AI. So, we will continue to drive forward innovations in analytics in 2022, informing the national conversation about data and health.

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Work to improve the Foundation

Our work to develop the Foundation and support our strategy continues, by investing in our people, how we work, the tools we use and the place we work in. 2022 will be dominated by a change in working patterns, following the removal of the need for social distancing.

z[People’s wellbeing and flexible ] working: In 2021 we created a new hybrid framework that offers people more choice over where and when they work. In 2022, we will test this in practice. Our office is open and people are using it more intentionally, appreciating the need to reconnect in person and the social value of work. We recognise it will take time for people to recover from the mental toll of the past few years, so we will be patient in our return to the office and continue to support colleagues’ wellbeing. We will provide the skills and tools people need to work seamlessly between home, office and online. Our leadership programme will be rolled out to more people with opportunities to develop other skills.

z[Improving our operational ] effectiveness and resilience: We strengthened our recruitment to respond to global churn. We will review our benefits to ensure we remain attractive to new and existing employees. Our investment in tools and skills includes new systems for managing grants, tools and training for analysts, project management, data visualisation and data and cyber security.

z[Building a more equitable, diverse ] and inclusive organisation: We continue to raise awareness, improve engagement and learning, while benchmarking our internal processes and linking our internal work to our strategy refresh.

z[Embedding environmental ] sustainability: As a responsible investor, we are strengthening engagement with our public equity managers and like-minded coalitions. As a consumer, we are building a picture of our footprint and developing ways to lighten it.

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Financial review and statements

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(Rough Illustration to be
updated with final)
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Legal and administrative information

Governors

Sir Hugh Taylor (Chair) Sir David Dalton Eric Gregory Loraine Hawkins Ruth Hussey Martyn Hole (stepped down 15 July 2021) Branwen Jeffreys Sharmila Nebhrajani (stepped down 30 July 2021) Melloney Poole (stepped down 31 December 2021) David Smart Rosalind Smyth Katie Blacklock (appointed 12 March 2021) Dawn Edge (appointed 12 March 2021) Ravi Gurumurthy (appointed 12 March 2021)

Charity number

286967

Investment Fund Managers

See Appendix

Company number

01714937

Registered office

8 Salisbury Square London EC4Y 8AP

External Auditor

UHY Hacker Young Quadrant House 4 Thomas More Square London E1W 1YW

Solicitors

Bircham Dyson Bell LLP 50 Broadway London SW1H 0BL

Custodian and Performance Measurement

Northern Trust 50 Bank Street Canary Wharf London E14 5NT

Investment Advisers

Cambridge Associates Limited 80 Victoria Street London SW1E 5JL

Redington 6th Floor 1 Angel Court London EC2R 7HJ

Bates Wells

10 Queen Street Place London EC4R 1BE

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Charitable activities in 2021

Our charitable expenditure

Our charitable expenditure is made up of:

Our charitable expenditure of £40.3m by strategic priority, allocating direct and support costs as appropriate, is illustrated in the chart below.

Figure 1: Charitable expenditure in 2021

----- Start of picture text -----
Other incl COVID-19
Healthy lives for all
Health and care sustainability
Improving national health
and care policy
Health and
care services Data analytics for
better health
Supporting health
care improvement
0% 5% 10% 15% 20% 25% 30% 35% 40%
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Our charitable expenditure of £40.3m compares to £42.8m in 2020. The key movements were:

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Further information can be found in note 7 to the accounts.

Our income used for charitable activities

Our charitable activities are mainly funded by our endowment. In 2021, we received £15.6m investment income and transferred £23.4m of capital from the endowment, in line with our expenditure policy.

We received restricted income of £1.2m (2020: £0.8m) primarily for Q, an initiative joint-funded with NHS Improvement. The Q initiative started in April 2015 and is part of our substantial long-term investments to develop and support initiatives designed to build capability.

45

Our policies

Expenditure policy

The investment spending policy, outlined in our investments section, sets out the spending formula for the Foundation. This spending formula provides a guide for the annual budget that may be adjusted to consider the needs of the Foundation and its operational capacity. The Foundation’s support and governance spend is set by reference to the total spend level to ensure it remains reasonable and proportionate.

Grant-making policy

The Foundation sets out specific entitlement criteria for each programme at its launch. These criteria vary from programme to programme and are made available on our website. Applications are assessed against these criteria and grants made considering funds available and the quality of applications. The period for which grants are awarded depends on the programme, but typically last between 1 and 4 years. Grants are monitored regularly, and appropriate progress reports are required from recipients.

Reserves policy

The Foundation holds an expendable endowment fund, which was created following the sale of PPP Healthcare Group (PPP) to Guardian Royal Exchange Group in 1998. It is the Foundation’s policy to operate as a perpetual body and, in line with this policy, the governors seek to manage the Foundation’s business, and in particular its investment returns and expenditure, to maintain the real value of this expendable endowment fund while providing the necessary income to fund the Foundation’s ongoing charitable activities.

Within the above overall policy, governors are at any time able to use endowment capital to fund charity expenditure. Accordingly, governors have determined that it is not necessary for the charity to hold reserves by way of separate unrestricted funds. Capital from the endowment equal to the excess of the Foundation’s expenditure over its generated unrestricted income is applied as income each year such that at the year end the unrestricted fund balance is nil.

46

Our investments

Investment policy and strategy

The governors have decided that the Foundation should operate as a perpetual endowment and seek to maintain the real value of the endowment. We aim to invest the Foundation’s assets to maximise returns while balancing risk through a diversified asset portfolio.

The Foundation has a structured investment process with the following primary features:

The governors’ primary objectives are:

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The main features of the Foundation’s investment strategy are to:

Our approach to responsible investment

We recognise the importance of being a responsible investor and have developed four guiding principles based on the values of the Foundation, which act as an overarching framework to strengthen the endowment’s investment strategy and stewardship credentials. The four responsible investment guiding principles are:

Principle 1 Work with, and challenge, existing and future investment managers to ensure their environmental, social and governance (ESG) integration and engagement policies align with the Foundation’s framework.

Principle 2 Exercise the right as a responsible asset owner through measured and relevant engagement in relation to the mission of the Foundation.

Principle 3 An ambition to be Net Zero by 2035 and report impact against UN Sustainable Development Goals 3 and 13 via robust oversight procedures and processes.

Principle 4 Emphasise positive engagement over exclusion, as long as there is no conflict of interest in the field of public health and health care.

We oversee the practical application and governance of the four guiding principles in accordance with the endowment’s ESG policy through engagement with the selected investment managers and investment

48

consultant. In addition, we require all our investment managers to have an ESG policy in place and recommend they adopt at least one of the following guidelines – the UK Stewardship Code or the UN Principles of Responsible Investment.

We do not invest directly in tobacco stocks. We also closely monitor our investment in pooled funds and if we identify any inadvertent exposure to tobacco stocks, we engage with the relevant investment manager with the aim of establishing new funds. There are certain stocks that could be seen as a conflict of interest for the mission of the Foundation and, therefore, we would negatively screen these stocks from the endowment. However, where possible, we adopt a formal approach to positive engagement where conflict of interest might arise. Where there are issues related to reputational risk, these reside with the board of governors.

The Health Foundation is a member of the Charities Responsible Investment Network, facilitated by ShareAction and maintains dialogue with investor coalitions such as Healthy Markets and Good Work. We intend that this will strengthen our approach to responsible investing where we want to use our investment portfolio to encourage businesses to behave responsibly.

Investment returns

Our long-term goals for the management of our endowment investments are set out in the Investment policy and strategy earlier in this report.

In 2021, the endowment fund returned a net of 14.4%, exceeding the RPI+5% target of 13.0% in that year. On a 3-year annualised basis, the fund returned 12.4%, exceeding the annual RPI+5% target of 8.9%. On a 5-year annualised basis, the fund exceeded the return target, achieving 9.1% per annum against the target of 8.8% per annum.

Figure 2 shows the change in the value of the investments. In 2021, the value of the investments increased by £106m, from £1,125m to £1,231m.

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Figure 2: Investment values as at 31 December 2021

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£1,400m
£1,231m
£1,200m £1,125m
£1,076m
£1,039m
£966m £980m
£1,000m
£800m
£600m
£400m
£200m
£m
2016 2017 2018 2019 2020 2021
----- End of picture text -----

The structure of the investments is focused on global investing via a range of asset classes. The investments look to maximise returns while balancing acceptable levels of risk through a diversified asset portfolio. Following a review of the existing public equity investment managers in 2021, a new suite of public equity investment managers was agreed to reflect our responsible investment guiding principles more appropriately. The portfolio successfully transitioned to the suite of new investment managers in the first half of 2022.

The Investment Committee meets quarterly and sets and regularly reviews the long-term investment strategy and progress on its implementation. Redington act as our investment advisor for the endowment and provide advice on strategic asset allocation, investments, and responsible investment practices. Cambridge Associates provides investment management services for the Victoria Fund and investment advice on private investments and hedge funds.

Figure 3 shows the target strategic asset allocation together with the actual asset allocation at the end of 2021. The allocation for 2021 was overweight in listed equities and cash and underweight in property and fixed income strategies. Over time we expect to increase our weighting in alternative assets as we build our private equity mandate.

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Figure 3: Asset allocation at 31 December 2021

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Listed equities Alternative assets Property and infrastructure
Fixed income strategies Cash
2%
Target 50% 27% 13% 8%
3%
Actual 57% 27% 9% 4%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
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We have enough liquidity in the portfolio to fund the charity’s plans for the foreseeable future, having carried out ‘stress-tests’ at appropriate intervals.

The total cost of managing our investments was £13.0m (2020: £14.7m). The reduction is mainly due to the decreased performance fees incurred on hedge funds. Further details can be found in note 6.

Subsidiary companies

The Foundation has two subsidiary undertakings Medtrust Innovations Limited (Medtrust) and the Victoria Fund LP Incorporated (Victoria Fund).

Medtrust is wholly owned by the Foundation as a mission-related investment engaged in the exploitation of intellectual property rights. In March 2011, Medtrust acquired 50% of the intellectual property rights of BMJ Quality & Safety , a journal published by the BMJ Publishing Group Limited. At 31 December 2021, Medtrust had fixed assets of £0.5m (2020: £0.5m). In the year, Medtrust generated an operating profit of £0.2m (2020: £0.2m).

The Victoria Fund was formed in February 2010 as a vehicle to invest in a combination of hedge funds and private equity. The Health Foundation, as the limited partner, is entitled to all investment returns less a priority share by the general partner. As at 31 December 2021, the Victoria Fund had fixed assets of £397m (2020: £337m) and the value of its net assets was £401m (2020: £346m). Net profit in the year was £56m (2020: £55m).

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Streamlined energy and carbon reporting

The Health Foundation is reporting energy and carbon emissions in compliance with The Companies (Directors’ Report) and Limited Liability Partnerships (Energy and Carbon Report) Regulations 2018. The conversion factors used in the report are taken from 2021 government guidance on the Streamlined Energy and Carbon Reporting (SECR) regime.

During 2021, much of the year was spent working from home with occasional periods in the office, in line with government restrictions. When restrictions around social distancing are lifted in 2022, we expect to balance working between home and office.

The Foundation consumed approximately 172,571 Kwh of energy in 2021 (2020: 309,942 Kwh) and CO2 emissions are estimated at 36.67 tonnes (2020: 66.27 tonnes). Our intensity ratio is 0.015 tonne per square metre of our office space (2020: 0.027 tonne per square metre).

Electricity and gas – office

During 2021, our office electric energy consumption equated to 152,167 Kwh (2020: 144,733 Kwh) or 32.31 tCO2e (2020: 33.74 tCO2e). The fall in tCO2e is because the conversion rate to tCO2 for electricity reduced from 0.233 in 2020 to 0.212 in 2021. In 2021, our office gas energy consumption equated to 20,404 Kwh (2020: 165,209 Kwh) or 3.74 tCO2e (2020: 30.38 tCO2e). Electricity costs are metered while gas costs form part of the service charge, apportioned by the landlord on the floor space occupied by the Foundation, which equates to 2,415 square metres.

Travel

During 2021, travel journeys paid for directly by the Foundation equated to 6,787 miles (2020: 24,814 miles) or 0.62 tCO2e (2020: 2.15 tCO2e). There was less travel in 2021 due to COVID-19 restrictions. Travel to and from Foundation events by external participants and attendees is not included in these calculations for both 2020 and 2021.

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Future reporting

The Foundation is committed to understanding and reducing its environmental impact. We have set targets for achieving net zero in our public equity investment portfolio. We developed a guide to sustainable events, awarding grants and recruitment. In addition, we are reviewing how to report on a wider set of measures, including commuting, working from home, water use, emissions from our cloud-based data storage and how we can reduce our carbon emissions from our operational activities. We will be considering sustainability in the Foundation's strategy refresh covering 2023–2026.

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2021 carbon reporting figures Mileage Consumption Carbon
kwh emission
tCO2e
Scope 2
Health Foundation office – gas 20,404 3.74
Health Foundation office – electricity 152,167 32.31
Scope 3
Employee mileage personal cars 233 0.07
Travel – taxis 70 0.02
Travel – public transport 5,495 0.21
Travel – air 989 0.32
Total gross emissions in tonnes CO2e 6,787 172,571 36.67
Intensity ratio: tonnes CO2e per sqm 0.015
2020 carbon reporting figures Mileage Consumption Carbon
kwh emission
tCO2e
Scope 2
Health Foundation office – gas 165,209 30.38
Health Foundation office – electricity 144,733 33.74
Scope 3
Travel – public transport 13,144 1.30
Travel – air 11,040 0.85
Total gross emissions in tonnes CO2e 24,184 309,942 66.27
Intensity ratio: tonnes CO2e per sqm 0.027
----- End of picture text -----

53

Stakeholder engagement – s.172 statement

The board recognises that the Health Foundation’s relationship with its stakeholders is critical to its success. The table below sets out our main stakeholder groups, the key considerations of each group and how we engage with them.

Stakeholder Key consideration How we engage
Key activities in
2021
Benefciaries,
including: members
of the public;
those who beneft
from the grants
we award; health
and care workers;
policymakers;
charities that received
donations from us.		 Improving the lives
of the people and
communities that the
Foundation’s grants
support in its work
to improve health,
health care and social
care in the UK.
Maximising the
impact of our work.
Sharing information
about the work of the
Foundation.		 Individual governors have
strategic oversight of key
programmes of work,
working closely with teams
across the Foundation and
the organisations we partner
with.
Via our grant holders,
including their reporting
to us.
Via benefciaries of charities
to which we have made
one-off donations through
the pandemic.
Through our webinars,
podcasts publications,
blogs, newsletters and
long reads, which are all
available to anyone, free
of charge.
We have an active social
media presence.
We have well-defned
communications strategies
around our strategic aims
and targeting our key
audiences.
The board approved
further donations to
charities to support
the national response
to the pandemic.
Working remotely
made engagement
harder, but the
board heard from
benefciaries of our
funded programmes
including hip fracture
outcomes; early
intervention on
eating disorders;
support for quality
improvement in
Scotland through
our Q network;
managing obstetric
emergencies in a
pandemic, among
others.

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Stakeholder Key consideration How we engage
Key activities in
2021
Partners: we work
closely with a wide
range of partners to
deliver our strategy.		 Maximising the
impact of our work.
We work with a wide
range of stakeholders
to deliver our mission
to build better health
and health care –
from national and
local government, to
the health and care
sector, the public
health, and the third
sector.
Ensuring the
effectiveness of
the programmes
and projects that
the Foundation
supports with grants
or contracts and/or
staff time.
Building and
maintaining networks
of people engaged in
improving the quality
of health, health care
and social care in
the UK.
Sharing information
about the work of the
Foundation.		 We engage with our
grant holders via ongoing
management of their
awards, with support for
applicants to enable them to
maximise the effectiveness
of the projects that we are
funding.
We cooperate actively with
other key organisations in
our feld to infuence policy
and practice.
We work with other key
organisations in some of our
major areas of activity and
engage with them closely in
ongoing management and
direction.
We have over 4,000
members in our Q
Community, supporting
service improvement and
learning.
We have an alumni
programme for previous
award-holders in our
fellowship programmes.
We have a wide variety of
useful, practical resources
on our website available at
no charge, aimed at people
and organisations working
in health, health care and
social care.
We create opportunities
for award-holders to meet
with governors at board
meetings.
Much of our work
is carried out
with partners.
Examples of board
engagement include
approving funding
for partnership
action on the wider
determinants of
health in Scotland;
approving the
next phase of the
European network
for senior health
leaders, Sciana;
understanding
health inequalities
impact of data-driven
technologies with
the Ada Lovelace
Institute; helping to
ensure innovation
happens in response
to the health needs
of minority ethnic
groups with NHS
AI lab; approving
funding for the
Improvement
Analytics Unit, using
novel counterfactual
analysis to assess
change programmes,
with NHSEI; working
with the Charities
Responsible
Investment Network
and other investor
coalitions to
promote the aims
of our responsible
investment policy.

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Stakeholder Key consideration How we engage
Key activities in
2021
Employees,
including: secondees,
interns, fellows,
longer term
temporary staff, etc.		 Ensuring that
employees enjoy
working at the
Foundation and are
motivated to help
deliver our mission.
Providing
opportunities to
develop and grow at
the Foundation.
Working to improve
health and wellbeing
of all who work at the
Foundation.
Working to improve
diversity and
inclusion at the
Foundation.		 Regular staff surveys with
follow-up of actions, shared
with the remuneration and
governance committee and
board.
Systematic and
comprehensive approach
to health and safety and
wellbeing overseen by
a staff team, reported
annually to the board.
Support for staff-led groups
on black diversity, mental
health awareness, LGBTQ+
and disability.
Learning and development
programme for all staff,
both corporate and
individual.
2021 was the
continuation of
a tough working
environment for
everyone. The
board reviewed
the results of two
staff surveys on
wellbeing at the start
and end of the year,
as well as surveys
on inclusion and
hybrid working. The
board reviews our
plans to improve our
approach to diversity
inclusion as well
as environmental
sustainability, both of
which have wide staff
engagement.
Suppliers, including:
the Foundation’s
investment
managers.		 That our key
suppliers are
operating ethically
as well as providing
value for money.		 As an accredited living wage
employer, ensure that our
contracted staff earn at least
the real living wage.
Regular contact with our
public equity investment
managers to ensure that
they remain properly
engaged on ethical and
socialgovernance.
The board
approved changes
to our investment
managers with a
greater emphasis on
responsible investing.

56

Risk management

The Foundation set out its approach to managing risk, including roles and responsibilities, in its risk management policy. The Audit Committee and the board of governors regularly review key risks owned by executive directors. The Audit Committee gives direction and reviews the implementation of the risk management process supported by an internal audit plan. Detailed below are the most important risks.

Keyrisk Nature of risk Management of risk
Investment risk Failure to provide adequate
funding for the Foundation’s
planned activities due to a
major correction in market
value and/or insuffcient
liquidity.		 The Investment Committee ensures that
the Foundation’s investments are suitably
diversifed, supported by an internal team,
external advisers and external benchmarking.
The committee ensures there is enough
continuing liquidity to meet the Foundation’s
cash requirements, in the event of a sudden
market correction. The Investment Committee
oversees investment portfolio risks, and the
Audit Committee oversees operational risks.
In 2021, we reviewed our 10-year strategy,
revised our investment target and agreed to
overhaul our public equity managers, which
we will do in 2022.
Cyber security The Foundation’s defences
are inadequate, rendering it
vulnerable to cyber-attack.		 The directors team supports a framework to
ensure employees are aware of the need for
information security. Management tests the
Foundation’s security regularly and the results
are reviewed independently. The Foundation
has a cyber-security service agreement to
monitor the networks and facilitate recovery.
In 2021, we achieved cyber security essentials
plus accreditation; carried out penetration
testing and established a compliance team
for cyber and data security. For 2022, we will
continue to conduct phishing tests, raise
awareness and train users.
Data security We suffer loss of data
because of a breach in
our security.		 Sensitive data is managed within a secure
data environment (SDE) with physical and
technical isolation from the offce environment,
accredited to ISO 27001. An internal working
group oversees compliance with the Data
Protection Act 2018, supported by a data
protection offcer.
In 2021, we improved our scores despite a
challenging environment and a signifcant
growth in our data. Our plans for 2022 include
widening responsibility for data security and
introducinga new IT platform for analysts.

57

Keyrisk Nature of risk Management of risk
Strategic The Foundation fails to
address important or
emerging issues or achieve
a desired level of impact.		 The board reviews our ambition, impact and
progress. This includes balancing short term
reactive work with longer term initiatives.
In 2021, we simplifed decision-making with
the ability to respond and adapt more quickly
to support the national response to the
pandemic. In 2022 we will refresh our strategy
for 2023–2025, informed by learnings from the
pandemic.
Quality Our work lacks suffcient
rigour, accuracy, quality and
objectivity.		 We have clear governance frameworks for
awards, contracts and research with a quality
assurance process for the release of all
published material.
In 2021, we strengthened our internal
processes andguidance.
Business disruption The Foundation fails to
take adequate care of the
safety and wellbeing of
its employees and loses
operational effectiveness,
due to disruption caused by
the pandemic.		 In 2020 we pivoted our priorities to supporting
the national response to the pandemic while
simultaneously adapting to working remotely.
In 2021, we gave people more choice over
where and when they work, with continuing
support for our wellbeing, in response to
what we learned through the pandemic. We
opened our offce for those that needed it and
briefy for everyone. We were able to maintain
our fexibility in reacting quickly to rapidly
changing demands from our benefciaries.
We started to experience an increase in people
leaving following a period of low turnover. We
ramped up our recruitment and in 2022 we will
review our benefts.

In 2021, we improved our risk management framework and reporting, with an increased use of risk to aid decision making. In 2022, we will revisit our risk appetite as part of our strategy refresh.

58

Trustees’ report

Structure, governance and management

The Health Foundation is a registered charity and a company limited by guarantee. It is governed by its memorandum and articles of association adopted on 24 July 1996 and last amended on 15 July 2021. The Foundation’s endowment was first established in 1998.

The board is responsible for the overall governance of the Foundation. All governors are members and directors of the company, and trustees of the registered charity. Governors are appointed for a term of 5 years and may be appointed for a second term of up to 4 years. The current governors and any past governors who served during the year are listed in the table below, together with the names of independent members of committees.

Name Member/
governor		 Audit
Committee		 Investment
Committee		 Remuneration
and Governance
Committee
Hugh Taylor Chair
David Dalton
Martyn Hole
(stepped down
15 July 2021)
Ruth Hussey Chair (from January
2022)
Sharmila
Nebhrajani
(stepped down
31 July 2021)		 Chair (until
July 2021)
Melloney Poole
(stepped down
31 December 2021)		 Chair (until December
2021)
Branwen Jeffreys
Rosalind Smyth
Loraine Hawkins
Eric Gregory Chair (from
August 2021)
David Smart Chair
Katie Blacklock
(appointed 12
March 2021)
Ravi Gurumurthy
(appointed 12
March 2021)
Dawn Edge
(appointed
12 March 2021)

59

The following served as independent members of committees during 2021.

Name Audit Committee Investment Committee
Mickola Wilson (stepped down
24 February 2021)
Ingeborg Dybdal Øie
Robert Beveridge
Mark Chaloner
Andrew Milligan

The board regularly reviews the skills and experience of the governors to ensure they are relevant to the Foundation’s mission and provide balance to the board.

The board meets at least four times a year and approves strategic, business plans and budgets and reviews operational and investment performance.

All new governors receive a comprehensive induction. Refresher sessions on relevant topics are arranged for governors periodically. In 2021, the board set time aside to discuss their roles as company directors and trustees, including the updated charity governance code for larger charities. The board agreed to carry out a review of its effectiveness, in 2022 following which it would review its approach to being diverse and inclusive. The articles of association were reviewed in 2020, adopted in 2021 and included setting a maximum number of trustees at 15.

Organisational structure and how decisions are made

The board of governors has set down a schedule of matters specifically reserved to it for decision. These include:

60

In addition, the following committees are established as committees of the board of the Foundation in accordance with the articles of association. Each operates in accordance with terms of reference, which ensures the committee is properly constituted with an appropriate membership of governors, experienced independent members (in the case of the Audit and Investment Committees) and a clear set of responsibilities and authorities.

The board of governors delegates the exercise of certain powers in connection with the management and administration of the Foundation to the leadership team managed by the chief executive.

Senior leadership

The chief executive is responsible for the day-to-day management of the Foundation’s affairs and for implementing policies agreed by the board of governors. The chief executive is assisted by a group of senior leaders who are listed below. Although the senior executive team are called directors, they are not the ‘legal’ directors of the charitable company.

61

Jennifer Dixon Chief Executive
Jo Bibby Director of Health
Aidan Kearney Chief Investment Offcer
Anita Charlesworth Director of Research and the REAL Centre
Cathy Irving Director of Strategy
Paul Hackwell Chief Operating Offcer
Adam Steventon Director of Data Analytics (until February 2022)
Will Warburton Director of Improvement (until January 2022)
Malte Gerhold Director of Improvement and Innovation (from May 2022)
Hugh Alderwick Director of Policy (from May 2022)
Sam Fletcher Director of Communications (from May 2022)
Charles Tallack Interim Director of Data Analytics (from February 2022)

The charity’s registered office and list of key advisers can be found in Legal and administrative information (p 43).

Principal activities and development

The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. It achieves this through supporting people and organisations. Further information on the charity’s activities and developments are included in the Strategic report.

Statement of governors’ responsibilities

The governors are responsible for the preparation of the annual report, including the strategic report and governors’ report, and the financial statements in accordance with applicable law and UK Generally Accepted Accounting Practice. Company law requires the governors to prepare financial statements for each financial year that give a true and fair view of the state of affairs of the charitable company and the group and of the incoming resources and application of resources, including the income and expenditure, of the charitable group for that period.

In preparing these financial statements, the governors are required to:

62

recommended accounting practice have been followed, subject to any material departures disclosed and explained in the financial statements

The governors have overall responsibility for ensuring that the Foundation has appropriate systems and controls, financial and otherwise. They are responsible for keeping adequate accounting records that disclose with reasonable accuracy at any time the financial position of the Foundation, and enable them to ensure that the financial statements comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the Foundation and for their proper application as required by charity law, and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities and to provide reasonable assurance that:

Each of the governors has confirmed that as far as they are aware, there is no relevant audit information of which the Foundation’s auditors are unaware. The governors have each taken all the steps necessary in order to make themselves aware of any relevant audit information and to establish that the Foundation’s auditors are aware of that information.

Processes are in place to ensure that performance is monitored, and that appropriate management information is prepared and reviewed regularly by both the directors’ team and the board of governors. Internal controls over all forms of commitment and expenditure continue to be refined to improve efficiency.

The systems of internal control are designed to provide reasonable but not absolute assurance against material misstatement or loss. They include:

63

Declarations and conflicts of interest policy

The Foundation has drawn up and implemented a declarations of interest policy that explains the nature of potential conflicts of interest. It requires governors, independent members of committees, employees and other defined categories of individual with whom the Foundation works from time to time, to declare all interests relevant to the Foundation’s work and provides a framework for managing situations when conflicts arise. Governors, independent members of committees and employees are also required to notify the Chief Executive or Chief Operating Officer of any association with a body or organisation which is or might become an applicant for funds from the Foundation. A register is kept and those interests declared by governors and members of the directors’ team are reviewed regularly by the directors and produced for inspection at all board meetings.

Details of transactions with related parties are set out in note 25 of the financial statements. The Foundation has a comprehensive whistle-blowing policy.

None of the governors has any beneficial interest in the company. All the governors are members of the company and guarantee to contribute £1 in the event of a winding up.

This Governors’ report, prepared under the Charities Act 2011 and the Companies Act 2006, was approved by the governors on 14 July 2022, in their capacities as trustees of the charity and directors of the company. This included their approval of the Trustees’ and strategic reports contained within it. The Trustees’ report is signed as authorised on their behalf by:

Hugh TaylorSigned Hugh Taylor (Jul 26, 2022 10:07 GMT+1)

Sir Hugh Taylor, Chair 14 July 2022

64

Independent auditor’s report to the members of the Health Foundation

Opinion

We have audited the financial statements of The Health Foundation (the ‘parent charitable company’) and its subsidiaries (the ‘group’) for the year ended 31 December 2021 which comprise the Consolidated Statement of Financial Activities, the Consolidated Balance Sheet, the Charity Balance Sheet, the Consolidated Statement of Cash Flows and notes to the financial statement, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards including FRS 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland (United Kingdom Generally Accepted Accounting Practice).

In our opinion the financial statements:

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditor’s responsibilities for the audit of the financial statements section of our report. We are independent of the group in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s

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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 statement 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 group or parent charitable company’s ability to continue as a going concern for a period of at least twelve 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 other than the financial statements and our auditor’s report thereon. The trustees are responsible for the other information contained within the financial statements. 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 there is a material misstatement in the financial statements or a material misstatement of the other information. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact.

We have nothing to report in this regard.

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Opinions on other matters prescribed by the Companies Act 2006

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

Matters on which we are required to report by exception

In the light of the knowledge and understanding of the group and the parent charitable company and its environment obtained in the course of the audit, we have not identified material misstatements in the strategic report or the trustees’ report.

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

Responsibilities of trustees

As explained more fully in the trustees’ responsibilities statement set out on page 62, the trustees 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.

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In preparing the financial statements, the trustees are responsible for assessing the group’s and the parent charitable 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 group or the parent charitable 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.

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:

Based on our understanding of the group and the industry in which it operates, we identified that the principal risks of non-compliance with laws and regulations related to the acts by the group, which were contrary to applicable laws and regulations including fraud, and we considered the extent to which non-compliance might have a material effect on the financial statements. We also considered those laws and regulations that have a direct impact on the preparation of the financial statements such as the Companies Act 2006. We evaluated management’s incentives and opportunities for fraudulent manipulation of the financial statements (including the risk of override of controls), and determined that the principal risks were related to inflated investment valuations and the group’s net assets at the year-end.

Audit procedures performed included: review of the financial statement disclosures to underlying supporting documentation, review of correspondence with legal advisors, enquiries of management and review of

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internal audit reports in so far as they related to the financial statements, and testing of journals and evaluating whether there was evidence of bias by the trustees that represented a risk of material misstatement due to fraud.

There are inherent limitations in the audit procedures described above and the further removed non-compliance with laws and regulations is from the events and transactions reflected in the financial statements, the less likely we would become aware of it. Also, the risk of not detecting a material misstatement due to fraud is higher than the risk of not detecting one resulting from error, as fraud may involve deliberate concealment by, for example, forgery or intentional misrepresentations, or through collusion.

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

Use of 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.

Colin Wright Colin Wright (Jul 26, 2022 17:39 GMT+1)

Colin Wright (Senior Statutory Auditor)

For and on behalf of UHY Hacker Young Chartered Accountants and Statutory Auditor

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Financial statements

Consolidated statement of financial activities for the year ended 31 December 2021

Notes Notes Unrestricted
fund
£’000		 Restricted
fund
£’000		 Expendable
Endowment
Fund
£’000		 Total
2021
£’000		 Total
2020
£’000
Income:
Charitable
activities		 3 244 1,178 – 1,422 938
Investments 4 15,638 – – 15,638 15,440
Capital
applied to
income		 5 23,365 – (23,365) – –
Total income 39,247 1,178 (23,365) 17,060 16,378
Expenditure:
Fund
management		 6 – – 13,038 13,038 14,654
Charitable
activities		 7 39,247 1,086 – 40,333 42,755
Total
resources
expended		 39,247 1,086 13,038 53,371 57,409
Operating
surplus/
(defcit)		 – 92 (36,403) (36,311) (41,031)
Net gain on
investments		 11 – – 149,068 149,068 93,716
Net income
for the year		 – 92 112,665 112,757 52,685
Fund
balances as
at 1 January
2021		 – 724 1,105,881 1,106,605 1,053,920
Fund
balances as at
31 December
2021		 – 816 1,218,546 1,219,362 1,106,605

The statement of financial activities includes all gains and losses recognised in the year.

All income and expenditure are derived from continuing activities.

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Consolidated balance sheet as at 31 December 2021

Notes Notes 2021
£’000
£’000		 2021
£’000
£’000		 2020
£’000
£’000		 2020
£’000
£’000
Fixed assets:
Intangible fxed assets 12 2,705 2,777
Tangible fxed assets 13 4,083 4,994
Investments 14 1,230,737 1,124,866
Programme-related investment 14 526 526
1,238,051 1,133,163
Current assets:
Debtors 16 1,371 1,945
Cash and short-term deposits 5,790 6,272
Total current assets 7,161 8,217
Current liabilities:
Amounts falling due within one year 17 (20,055) (24,901)
Net current liabilities (12,894) (16,684)
Total assets less current liabilities 1,225,157 1,116,479
Creditors: amounts falling due after
more than 1year		 18 (5,167) (9,227)
Provisions for liabilities 20 (628) (647)
Net assets 1,219,362 1,106,605
Capital funds:
Endowment funds general 1,218,546 1,105,881
Income funds:
Unrestricted fund – –
Restricted funds 816 724
Total funds 1,219,362 1,106,605

The accounts were approved by the governors, and authorised for issue on 14 July 2022 and signed by:

Hugh Taylor Hugh Taylor (Jul 26, 2022 10:07 GMT+1) Sir Hugh Taylor Trustee

Eric Gregory Eric Gregory (Jul 19, 2022 08:41 GMT+1) Eric Gregory Trustee

Company Registration No. 01714937

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Charity balance sheet as at 31 December 2021

Notes Notes 2021
£’000
£’000		 2021
£’000
£’000		 2020
£’000
£’000		 2020
£’000
£’000
Fixed assets:
Intangible fxed assets 12 2,705 2,777
Tangible fxed assets 13 4,083 4,994
Investments 14 829,694 779,326
Other Investments 14 401,569 346,066
1,238,051 1,133,163
Current assets:
Debtors 16 1,136 1,778
Cash and short-term deposits 5,789 6,272
Total current assets 6,925 8,050
Current liabilities:
Amounts falling due within one year 17 (20,055) (24,901)
Net current liabilities: (13,130) (16,851)
Total assets less current liabilities 1,224,921 1,116,312
Creditors: amounts falling due after
more than 1year		 18 (5,167) (9,227)
Provisions for liabilities 20 (628) (647)
Net assets 1,219,126 1,106,438
Capital funds
Endowment funds general 1,218,310 1,105,714
Income funds
Unrestricted fund – –
Restricted funds 816 724
Total funds 1,219,126 1,106,438

The accounts were approved by the governors, and authorised for issue on 14 July 2022 and signed by:

Hugh Taylor

Hugh Taylor (Jul 26, 2022 10:07 GMT+1)

Sir Hugh Taylor Trustee

Eric Gregory Eric Gregory (Jul 19, 2022 08:41 GMT+1) Eric Gregory Trustee

Company Registration No. 01714937

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Consolidated statement of cash flows for the year ended 31 December 2021

Notes Notes 2021
£’000
£’000		 2021
£’000
£’000		 2020
£’000
£’000		 2020
£’000
£’000
Cash fows from operating activities:
Cash absorbed by operations 27 (45,614) (43,169)
Investment activities:
Cost of developing intangible assets (653) (267)
Purchase of tangible fxed assets (12) (288)
Investment proceeds re-invested (15,638) (15,406)
Withdrawals from investments 58,835 60,395
Investment management fees (13,038) (14,654)
Investment income 15,638 15,440
Net cash generated from investing
activities		 45,132 45,220
Net (decrease)/increase in cash and
cash equivalents		 (482) 2,051
Cash and cash equivalents at
beginningof year		 6,272 4,221
Cash and cash equivalents at end
of year		 5,790 6,272

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Notes to the financial statements for the year ended 31 December 2021

Charity information

The Health Foundation is a private company limited by guarantee incorporated in England and Wales. The registered office is 8 Salisbury Square, London EC4Y 8AP.

The liability of the governors in their capacity as members of the company is limited. Each member guarantees any deficiency in the Foundation to a maximum of £1.

1.0 Accounting policies

1.1 Accounting convention

These accounts have been prepared in accordance with The Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102), Accounting and Reporting by Charities, the Statement of Recommended Practice for charities applying FRS 102, the Companies Act 2006 and UK Generally Accepted Accounting Practice. The Foundation is a Public Benefit Entity as defined by FRS 102.

The accounts are prepared in sterling, which is the functional currency of the Foundation. Monetary amounts in these financial statements are rounded to the nearest £’000.

The accounts have been prepared under the historical cost convention, modified to include certain financial instruments at fair value. The principal accounting policies adopted are set out below.

1.2 Basis for consolidation

The financial statements consolidate the charity and its wholly owned subsidiary entities, The Victoria Fund LP Incorporated and Medtrust Innovations Limited.

In accordance with section 408 of the Companies Act 2006, no separate Statement of Financial Activities has been presented for the charity.

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However, due to the nature of the charity’s subsidiaries, the overall net movement in funds of the charity is the same for the group.

1.3 Going concern

At the time of approving the financial statements, the governors have a reasonable expectation that the Foundation has adequate resources to continue in operational existence for the foreseeable future. This expectation includes an assessment of the ongoing impact of COVID-19 and political and economic challenges facing global markets. Our endowment grew in value in 2021. There is market uncertainty which may lead to some volatility, but the governors are confident that the current governance structure, delegated to an experienced and stable investment committee overseeing a globally diversified and risk aware portfolio of investments is well placed to cope. We have enough liquidity in the portfolio to fund the charity’s plans for the foreseeable future. Under our normal internal governance procedures, we conducted a Strategic Asset Allocation review in 2021 and continue to monitor this in light of ongoing uncertainties. Thus, the governors continue to adopt the going concern basis of accounting in preparing the financial statements.

1.4 Charitable funds

The Foundation maintains three types of funds: unrestricted funds, restricted funds and expendable endowment funds. Income and expenditure on these funds are shown separately in the statement of the financial activities.

Unrestricted funds are available for use at the discretion of the governors in furtherance of their charitable objectives unless the funds have been designated for other purposes. The income is made up of investment income, other incoming resources and any capital applied as income.

Restricted funds are subject to specific conditions as to how they may be used. The purposes and uses of the restricted funds are set out in the notes to the accounts.

Expendable endowment funds represent capital gifted for the long-term benefit of the Foundation. Any income arising from the Endowment fund assets is added to the unrestricted fund. The trustees may also, at their discretion, determine to apply part or all of the endowment capital as income at which time the relevant amounts are transferred to the unrestricted fund.

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1.5 Incoming resources

Income is recognised when dividends and interest are receivable and includes recoverable taxation. Income received but not distributed by pooled funds is included as part of the net gains on investments in the statement of financial activities.

1.6 Resources expended

Expenditure is recognised on an accruals basis. Irrecoverable VAT is included within the expense items to which it relates.

Expenditure on raising funds represents amounts paid to the Foundation’s external investment advisers and custodian, and an apportionment of internal support costs based on time spent. They are charged to the endowment fund, as the primary role of the investment managers and the custodian is to safeguard the investment assets of the Foundation.

Charitable activities comprise all costs incurred in the pursuit of charitable objects. These are:

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1.7 Intangible fixed assets other than goodwill

Research expenditure is written off against profits in the year in which it is incurred. Identifiable development expenditure is capitalised to the extent that the technical, commercial and financial feasibility can be demonstrated.

Intangible assets are defined as having finite useful lives and the costs are amortised on a straight-line basis over the term of the project life, estimated to be between 3 and 7 years. Intangible assets are stated at cost less amortisation and are reviewed for impairment whenever there is an indication that the carrying value may be impaired.

1.8 Tangible fixed assets

Tangible fixed assets are initially measured at cost and subsequently measured at cost or valuation, net of depreciation and any impairment losses. Tangible fixed assets with a value over £5,000 are capitalised. Depreciation is recognised to write off the cost or valuation of assets less their residual values over their useful lives on the following bases:

The gain or loss arising on the disposal of an asset is determined as the difference between the sale proceeds and the carrying value of the asset and is recognised in net income/(expenditure) for the year.

1.9 Fixed asset investments

Fixed asset investments comprise both quoted and unquoted investments and are initially measured at transaction price, excluding transaction costs, and are subsequently measured at fair value at each reporting date. Changes in fair value are recognised in net income/(expenditure) for the year. Transaction costs are expensed as incurred.

Quoted investments are listed shares, bonds and units and are stated at fair value on the basis equivalent to market value using the bid price. Asset sales and purchases are recognised at the date of trade.

Unquoted investments are stated at fair value based on professional valuations at the balance sheet date or nearest available date to it. For hedge

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funds, the valuations are provided by third-party hedge fund administrators. In the case of private equity funds, there is no readily identifiable market price. These funds are included at the most recent valuations by their respective managers. Investments made shortly before the balance sheet date are held at cost where the managers have yet to provide a valuation.

A subsidiary is an entity controlled by the Foundation. Control is the power to govern the financial and operating policies of the entity to obtain benefits from its activities. Subsidiaries are included in the Foundation’s balance sheet at their net asset value which represents the fair value of their underlying investments and other net assets. Investments in subsidiary undertakings are held at cost less any impairment.

Unrealised gains and losses are recognised at the year-end as the difference between the historical cost and the market value of the investment assets. Realised gains and losses are recognised during the year at the time the investment is sold, and include any fees incurred at source. All unrealised and realised gains and losses on investments are included within the statement of financial activities.

1.10 Impairment of fixed assets

Impairment of tangible and intangible fixed assets are reviewed annually and any impairment is recognised as an expense in the year that it occurs.

1.11 Cash and cash equivalents

Cash and cash equivalents include cash in hand, deposits held at call with banks, other short-term liquid investments with original maturities of 3 months or less, and bank overdrafts. Bank overdrafts are shown within borrowings in current liabilities.

1.12 Financial instruments

The Foundation has elected to apply the provisions of Section 11 ‘Basic Financial Instruments’ and Section 12 ‘Other Financial Instruments Issues’ of FRS 102 to all of its financial instruments.

Financial instruments are recognised in the Foundation’s balance sheet when the Foundation becomes party to the contractual provisions of the instrument.

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Financial assets and liabilities are offset, with the net amounts presented in the financial statements, when there is a legally enforceable right to set off the recognised amounts and there is an intention to settle on a net basis or to realise the asset and settle the liability simultaneously.

Basic financial assets

Basic financial assets, which include debtors and cash and bank balances, are initially measured at transaction price including transaction costs and are subsequently carried at amortised cost using the effective interest method unless the arrangement constitutes a financing transaction, where the transaction is measured at the present value of the future receipts discounted at a market rate of interest.

Financial assets classified as receivable within 1 year are not amortised.

Basic financial liabilities

Basic financial liabilities, including trade creditors and grants payable are initially recognised at transaction price unless the arrangement constitutes a financing transaction, where the debt instrument is measured at the present value of the future receipts discounted at a market rate of interest. Financial liabilities classified as payable within 1 year are not amortised.

Debt instruments are subsequently carried at amortised cost, using the effective interest rate method.

Trade creditors are obligations to pay for goods or services that have been acquired in the ordinary course of operations from suppliers. Amounts payable are classified as current liabilities if payment is due within 1 year or less. If not, they are presented as non-current liabilities. Trade creditors are recognised initially at transaction price and subsequently measured at amortised cost using the effective interest method.

Derecognition of financial liabilities

Financial liabilities are derecognised when the Foundation’s contractual obligations expire or are discharged or cancelled.

1.13 Provisions

Provisions are recognised when the Foundation has a legal or constructive present obligation as a result of a past event, it is probable that the Foundation will be required to settle that obligation and a reliable estimate can be made of the amount of the obligation.

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The amount recognised as a provision is the best estimate of the consideration required to settle the present obligation at the reporting end date, taking into account the risks and uncertainties surrounding the obligation.

Where the effect of the time value of money is material, the amount expected to be required to settle the obligation is recognised at present value. When a provision is measured at present value the unwinding of the discount is recognised as a finance cost in net income/(expenditure) in the period it arises.

1.14 Employee benefits

The cost of any unused holiday entitlement is recognised in the period in which the employee’s services are received.

Termination benefits are recognised immediately as an expense when the Foundation is demonstrably committed to terminate the employment of an employee or to provide termination benefits.

1.15 Retirement benefits

Retirement pensions and related benefits to defined contribution schemes are charged to the unrestricted fund in the accounting year in which the contributions are paid.

1.16 Leases

Rentals payable under operating leases, including any lease incentives received, are charged to income on a straight-line basis over the term of the relevant lease.

1.17 Foreign exchange

Transactions in currencies other than pounds sterling are recorded at the rates of exchange prevailing at the dates of the transactions. At each reporting end date, monetary assets and liabilities that are denominated in foreign currencies are retranslated at the rates prevailing on the reporting end date. Gains and losses arising on translation are included in net income/ expenditure for the period.

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1.18 Exemptions

The charitable company has taken advantage of the exemptions in FRS 102 not to present a company only cash flow statement and certain disclosures about the company’s financial instruments. The company has taken advantage of the legal dispensation granted under s.408 of the Companies Act 2006 allowing it not to present its own statement of financial activities. The financial statements contain the consolidated statement of financial activities only. The company’s net income for the year is £112,688k (2020: £52,693k).

2.0 Critical accounting estimates and judgements

In the application of the Foundation’s accounting policies, the governors are required to make judgements, estimates and assumptions about the carrying amount of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered relevant. Actual results may differ from these estimates.

The estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting estimates are recognised in the period in which the estimate is revised where the revision affects only that period, or in the period of the revision and future periods where the revision affects both current and future periods.

The estimates and assumptions that have a significant risk of causing a material adjustment to the carrying amount of assets and liabilities are outlined below:

Investment valuation

The Foundation’s investments are stated at market value. Fixed asset investments comprise both quoted and unquoted investments and are initially measured at transaction price, excluding transaction costs, and are subsequently measured at fair value at each reporting date. Changes in fair value are recognised in net income/(expenditure) for the year. Transaction costs are expensed as incurred. Valuations are obtained from the investment managers. The governors do not believe that there is any inherent uncertainty in the presentation of these amounts, and that in their judgement, market value and fair value may be regarded as identical for the purposes of these accounts.

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3.0 Income from charitable activities

Share of
proft in
BMJ Quality
& Safety
£’000		 Other
income
£’000		 Total
2021
£’000		 Total
2020
£’000
Other income* 244 1,178 1,422 938
Analysis by funds:
Unrestricted funds 244 – 244
Restricted funds – 1,178 1,178
244 1,178 1,422
For year ended 31 December
2020:
Unrestricted funds 169 – 169
Restricted funds – 769 769
169 769 938

*In 2021, we received restricted income of £1,178k (2020: £1,013k, adjusted down by £244k due to overstatement in 2019) from NHS Improvement for Q, a jointly funded initiative.

4.0 Investments

2021
£’000		 2020
£’000
Income from listed investments 10,407 10,139
Fixed interest income 486 377
Property fund income 4,089 3,993
Income from alternative investments 656 931
15,638 15,440

5.0 Capital applied to income

Unrestricted
funds
£’000		 Endowment
funds
general
£’000		 Total
2021
£’000		 Total
2020
£’000
Released from endowment
funds during2021		 23,365 (23,365) – –
For the year ended
31 December 2020		 26,624 (26,624) – –

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6.0 Fund management

6.0
Fund management
2021
£’000		 2020
£’000
Cost of fund management:
Investment advisory costs 230 95
Staff costs 288 283
Custodian fees 269 189
Investment managers’ fees 12,251 14,087
13,038 14,654

Investment management fees

The investment managers’ fees of £12,251k (2020: £14,087k) includes: management fees of £9,850k (2020: £8,778k), incurred on the endowment value of £1,230,737k (2020: £1,124,866k) and performance fees of £1,378k (2020: £4,432k). Markets were volatile in 2020, enabling a number of hedge fund strategies to extract higher returns. As a result, performance fees were higher in that year.

The cost of raising funds is approximately 1.1% of the endowment value (2020: 1.3%).

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7.0 Expenditure on charitable activities

Improving
health and
care services
£’000		 Promoting
healthy lives
for all
£’000		 Others
£’000		 Total 2021
£’000		 Total 2020
£’000
Grant funding
of activities
(see note 28)		 8,871 4,854 2,874 16,599 20,174
Direct costs* 8,264 4,522 605 13,391 12,750
Share support
costs*		 6,316 3,456 462 10,234 9,713
Share of
governance
costs*		 67 37 5 109 118
23,518 12,869 3,946 40,333 42,755
*See note 8
Analysis by
fund:
Unrestricted
funds		 22,432 12,869 3,946 39,247 42,233
Restricted
funds		 1,086 – – 1,086 522
23,518 12,869 3,946 40,333 42,755

Grant funding was higher in 2020, as we gave more donations and grants in response to the pandemic, and we made a significant adjustment to our funding of THIS Institute. In 2021, we increased our spending on promoting healthy lives.

For the year ended 31 December 2020

Improving
health and
care services
£’000		 Promoting
healthy lives
for all
£’000		 Others
£’000		 Total
£’000
Unrestricted funds 27,074 3,947 11,212 42,233
Restricted funds 522 522
27,596 3,947 11,212 42,755

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8.0 Support and direct costs

Direct costs
£’000		 Support
costs
£’000		 Governance
costs
£’000		 2021
£’000		 2020
£’000
Staff costs 11,200 2,144 – 13,344 12,048
Depreciation – 1,648 – 1,648 1,600
Property costs – 1,699 – 1,699 1,657
Technology
costs		 37 2,565 – 2,602 2,517
Other direct/
support costs		 2,154 2,130 – 4,284 4,624
Audit fees – – 36 36 27
Legal and
professional		 – 48 25 73 64
Internal audit – – 35 35 29
Other
governance
costs		 – – 13 13 15
13,391 10,234 109 23,734 22,581

Direct costs of charitable activities are mainly to further the Foundation’s objectives by: organising conference and events; carrying out direct and commissioned work in-house; scoping, developing and managing grant programmes, and publishing and disseminating reports on research findings.

Support costs have been allocated to charitable activities in the year.

Governance costs include payments to auditors of £36k (2020: £27k) for audit fees and £2k (2020: £1k) for non-audit services. The reported audit fees in 2020 were lower because they include prior year adjustments. Without these, the increase is less than £2k.

9.0 Governors

None of the governors (or any persons connected with them) received any remuneration or benefits from the Foundation during the year. Trustees expenses received totalled £0.3k (2020: £1k).

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10.0 Employment costs

2021
£’000		 2020
£’000
Wages and salaries 11,389 10,173
Social security costs 1,248 1,129
Other pension costs 1,011 914
Other costs (27) 103
13,621 12,319

The average number of employees during the year was 203 (2020: 187), which equated to a full-time equivalent of 196 (2020: 177).

Employment costs include salary costs relating to management of the endowment of £277k (2020: £271k).

The number of employees whose annual remuneration was £60,000 or more were:

more were:
2021 2020
£60,001–£70,000 18 15
£70,001–£80,000 9 7
£80,001–£90,000 6 9
£90,001–£100,000 – 1
£100,001–£110,000 5 3
£110,001–£120,000 1 2
£130,001–£140,000 – 1
£140,001–£150,000 1 –
£160,001–£170,000 2 3
£170,001–£180,000 1 –
£240,001–£250,000 – 1
£250,001–£260,000 1 –

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11.0 Net gains on investments

11.0 Net gains on investments
2021
£’000		 2020
£’000
Revaluation of investments 149,068 93,716

Net revaluation of investments comprises:

12.0 Intangible fixed assets

12.0 Intangible fxed assets
Software
£’000		 Q Initiative
£’000		 Total
£’000
Cost:
At 1 January 2021 2,098 2,186 4,284
Additions – internally developed 652 – 652
Write-offs (6) – (6)
At 31 December 2021 2,744 2,186 4,930
Amortisation and impairment:
At 1 January 2021 883 624 1,507
Amortisation charge in the year 408 312 720
Write-offs (2) – (2)
At 31 December 2021 1,289 936 2,225
Carrying amount:
At 31 December 2021 1,455 1,250 2,705
At 31 December 2020 1,215 1,562 2,777

Software includes (i) our key office applications, upgraded in 2018 with a useful life of 7 years. These include Office 365, SharePoint and Salesforce CRM; (ii) our secure data environment, which we are replacing in 2022.

Additions include (i) our grant management system, which launched in 2021 and will be fully implemented in 2022; and (ii) our new platform for analysts which replaces our secure data environment and provides tools for large open data sets. Work started in 2021 and will be completed in 2022.

87

The Q Initiative identifies and connects people skilled in improvement across the UK, through online and events-based capabilities that promote knowledge sharing, development, and other improvement activities. The infrastructure work was completed in January 2019 with a useful life of 7 years.

13.0 Tangible fixed assets

13.0 Tangible fxed assets
Fixtures and
fttings
£’000		 Computer
equipment
£’000		 Total
£’000
Cost:
At 1 January 2021 5,363 1,491 6,854
Additions – 12 12
Write-offs – (43) (43)
At 31 December 2021 5,363 1,460 6,823
Depreciation:
At 1 January 2021 872 988 1,860
Depreciation charge in the year 625 298 923
Write-offs – (43) (43)
At 31 December 2021 1,497 1,243 2,740
Carrying amount:
At 31 December 2021 3,866 217 4,083
At 31 December 2020 4,491 503 4,994

The additions of £12k relate to the purchase of new computer equipment including replacement laptops.

88

14.0 Fixed assets investments

14.0 Fixed assets investments
Investments
Group Portfolio
£’000		 Other
£’000		 Total
£’000
Valuation:
At 1 January 2021 1,124,866 526 1,125,392
Valuation changes 149,068 – 149,068
Income 15,638 – 15,638
Investment management costs included in
the fund		 (9,618) – (9,618)
Net withdrawals from portfolio (49,217) – (49,217)
At 31 December 2021 1,230,737 526 1,231,263
Cost:
At 31 December 2021 946,510 526 947,036
At 31 December 2020 899,257 526 899,783
Notes 2021
£’000		 2020
£’000
Other investments comprise:
Programme-related investments 26 526 526
Investments at fair value comprise:
Property funds 94,992 96,106
Equities 690,111 637,591
Fixed interest 50,242 50,977
Alternatives 368,449 311,035
Cash 26,943 29,157
1,230,737 1,124,866

89

Investments
Charity Portfolio
£’000		 Other
£’000		 Total
£’000
Valuation:
At 1 January 2021 779,326 346,066 1,125,392
Valuation changes 88,001 61,067 149,068
Income 13,944 1,694 15,638
Investment management costs included in
the fund		 (2,360) (7,258) (9,618)
Net withdrawals from portfolio (49,217) – (49,217)
At 31 December 2021 829,694 401,569 1,231,263
Cost:
At 31 December 2021 669,796 277,241 947,036
At 31 December 2020 666,841 232,942 899,783
Other investments comprise:
Notes		 2021
£’000		 2020
£’000
Investment in subsidiaries 401,043 345,540
Programme-related investments 526 526
26 401,569 346,066
Investments at fair value comprise:
Property funds 94,992 96,106
Equities 690,111 637,590
Fixed interest 18,479 19,214
Alternatives 536 474
Cash 25,576 25,942
829,694 779,326

A currency hedging programme was in place during the year to manage foreign currency exchange risk. At 31 December 2021, the group had open foreign exchange forward contracts, to mitigate any currency risk between USD and Sterling on the hedge fund mandate in the Victoria Fund. These contracts have been revalued at the applicable year-end revaluation rate, and the resulting unrealised gains/(losses) are included within the overall value of the investments above. At 31 December 2021, the Victoria Fund held contracts to buy $68,049k (£50,592k at an average rate of $1.35) and £163,194k ($223,398k at an average rate of $1.36) (2020: $68,183k and £181,726k). The unrealised loss associated with these forward currency contracts totalled (£2,175k) as at 31 December 2021 (2020: unrealised gain £9,853k).

90

The Victoria Fund’s underlying hedge fund investments provide varying degrees of liquidity based on their own redemption terms, which typically begin with an initial lock-up period. These investments are made on an ongoing basis. As a result, the Victoria Fund may not be able to liquidate all its investments quickly. As investment lock-up periods ease in future periods, more short-term liquidity is expected.

The following table illustrates the expected liquidity of assets and liabilities held by the Victoria Fund as at 31 December 2021:

Less than
6 months
£’000		 6–12
months
£’000		 More than
12 months
£’000		 Long-term
lock up*
£’000
Total non-current assets – – – 244,775
Total current assets 144,153 15,376 – –
Total current liabilities (2,936) – – –

*This relates to underlying funds in the Victoria Fund, whose redemptions have been locked up and private equity funds which have no redemption opportunities.

At the balance sheet date, the Foundation had total unfunded investment commitments of £113,122k (2020: £118,193k) for private equity and infrastructure from total commitments of £312,625k (2020: £273,626k). These commitments form part of the planned asset allocation and will be met from within the existing investments.

91

15.0 Financial instruments

Group 2021
£’000		 2020
£’000
Carrying amount of fnancial assets:
Debt instruments measured at amortised cost 6,143 7,238
Instruments measured at fair value through proft or loss 1,230,737 1,124,866
Carrying amount of fnancial liabilities:
Measured at amortised cost 25,222 34,128
Charity 2021
£’000		 2020
£’000
Carrying amount of fnancial assets:
Debt instruments measured at amortised cost 5,907 7,071
Instruments measured at fair value through proft or loss 829,694 779,326
Carrying amount of fnancial liabilities:
Measured at amortised cost 24,944 34,105

16.0 Debtors: Amounts falling due within 1 year

Group Group Charity Charity
2021
£’000		 2020
£’000		 2021
£’000		 2020
£’000
Other debtors 353 966 118 799
Prepayments 1,018 979 1,018 979
1,371 1,945 1,136 1,778

92

17.0 Creditors: Amounts falling due within 1 year

Group Group Charity Charity
2021
£’000		 2020
£’000		 2021
£’000		 2020
£’000
Trade creditors 604 534 604 534
Grants payable 15,038 19,983 15,038 19,983
Other creditors 2,342 2,673 2,342 2,673
Accruals and deferred income 2,071 1,711 2,071 1,711
20,055 24,901 20,055 24,901

18.0 Creditors: Amounts falling due after more than 1 year

Group Group Charity Charity
2021
£’000		 2020
£’000		 2021
£’000		 2020
£’000
Grants payable – in 2 to 5 years 5,167 9,227 5,167 9,227

The reduction is mainly due to the unwinding of the THIS Institute provision, reflecting the ongoing work on the award. THIS Institute is now in year five of the award and we anticipate full commitment to the second phase, with a value of £22.8m, in 2022.

19.0 Grants payable

2021
£’000		 2020
£’000
As at 1 January 29,210 32,450
Grants committed in the year 16,187 19,506
Paid during the year (25,192) (22,746)
As at 31 December 20,205 29,210
Split into:
Grants payable – due within 1 year 15,038 19,983
Grants payable – in 2 to 5 years 5,167 9,227
As at 31 December 20,205 29,210

93

20.0 Provisions for liabilities

2021
£’000		 2020
£’000
Pension obligations (see note 21) 546 570
Dilapidations 82 77
628 647
Movement on provisions:
Pension
obligations
£’000		 Dilapidations
£’000		 Total
£’000
At 1 January 2021 570 77 647
Adjustment (24) 5 (19)
At 31 December 2021 546 82 628

21.0 Retirement benefit schemes

a) AEGON Group Personal Pension Plan

The Health Foundation offers all current employees the opportunity to join the defined contribution Group Personal Pension Plan provided by AEGON. Contributions in the year were £1,011k (2020: £913k). There was £6k in outstanding contributions at 31 December 2021 (2020: £2k).

b) Other retirement benefits

The Foundation has an unfunded future commitment to a former employee. The contractual commitment (as defined in each contractual arrangement) is to pay a pension equivalent to 1/60th of their pensionable salary for each year of pensionable service less any amounts of pension paid to the same members under The Pensions Trust Growth Plan. The potential pension liability at 31 December 2021, based on advice from an actuary, is estimated to be £546k (2020: £571k). This provision will be reviewed in 2022.

94

22.0 Analysis of net assets between funds

Group Unrestricted
fund
£’000		 Restricted
fund
£’000		 Expendable
Endowment
Fund
£’000		 Total
£’000
Fund balances at 31 December
2021 are represented by:
Intangible fxed assets 2,705 – – 2,705
Tangible assets 4,083 – – 4,083
Programme related 526 – – 526
Investments 11,445 – 1,219,292 1,230,737
Current (liabilities)/assets (12,964) 816 (746) (12,894)
Longterm liabilities (5,167) – – (5,167)
Provisions (628) – – (628)
– 816 1,218,546 1,219,362
Charity Unrestricted
fund
£’000		 Restricted
fund
£’000		 Expendable
Endowment
Fund
£’000		 Total
£’000
Fund balances at 31 December
2021 are represented by:
Intangible fxed assets 2,705 – – 2,705
Tangible assets 4,083 – – 4,083
Investments 12,207 – 817,487 829,694
Investment in subsidiary – – 401,569 401,569
Current (liabilities)/assets (13,200) 816 (746) (13,130)
Long-term liabilities (5,167) – – (5,167)
Provisions (628) – – (628)
– 816 1,218,310 1,219,126

23.0 Financial commitments

The Foundation has a number of contracts that have been entered into that are not recognised as liabilities as they are severable. They cover technical support for our award holders, evaluation and operational services. They are recognised on a cash basis as and when the expenditure is incurred. These amounted to £17,957k at 31 December 2021 (2020: £12,443k).

95

24.0 Operating lease commitments

At 31 December 2021, the company had a property lease for its office premises that expires in September 2028. The future minimum lease payments are as follows:

Land and buildings Land and buildings Machinery Machinery
2021
£’000		 2020
£’000		 2021
£’000		 2020
£’000
Expiry date:
Within 1 year 1,650 1,650 15 25
Between 2 and 5 years 6,605 6,605 – 15
Over 5 years 2,889 4,539 – –

25.0 Related party transactions

Due to the specialist nature of the projects funded, circumstances may occasionally arise where governors, committee members or staff are associated with organisations which apply for grants. In such cases, the Foundation has clear policies and procedures to ensure that the governor, committee member or member of staff is not involved in the assessment or approval of the grant. All such transactions are undertaken on an arm’s length basis in accordance with the normal grant assessment and arrangements. Details of governors and senior management who have interests in organisations to which the Foundation has made awards or contracted within 2021 are noted in the table below.

96

Role in associated
organisation		 Associated organisation
Board member
Sir David Dalton Chief Executive (interim) Liverpool University Hospitals NHS
Foundation Trust
Sir Hugh Taylor Chair King’s College Hospital Foundation Trust
Ruth Hussey Honorary Professor University of Liverpool
Professor Rosalind
Smyth		 Chair of starter grants
panel		 Academy of Medical Sciences
Dr Ruth Hussey Honorary Professor University of Liverpool
David Smart Trustee BEAT Eating disorders
Senior Management
Jennifer Dixon Honorary Doctor of
Science		 University of Bristol
Joanna Bibby Board Member Business for Health CIC
Will Warburton Honorary Research Fellow Imperial College London
Anita Charlesworth Honorary Professor University of Birmingham

During the year, Victoria Fund LP Incorporated, a subsidiary of the Foundation, received no investment contributions from the charity (2020: £0). Medtrust Innovations Limited, a subsidiary of the Foundation, donated its profit of £169k (2020: £177k) to the Foundation.

Remuneration of key management personnel

Key management personnel are considered to be the Chief Executive Officer and others as set out in the senior management section of the Trustee’s Report. Total remuneration of this group in the year, was as follows:

2021
£’000		 2020
£’000
Key management personnel 1,222 1,216

26.0 Subsidiaries

The Foundation had two subsidiary undertakings and the details at 31 December 2021 are as follows:

Name of
undertaking		 Registered
offce		 Nature of
business		 Class of shares
held		 % Held Direct
Indirect
Medtrust
Innovations
Limited		 England and
Wales		 Intellectual
property		 Ordinary 100.00
The Victoria Fund
LP Incorporated		 Guernsey Investment fund
vehicle		 – –

97

Medtrust Innovations Limited (Medtrust)

Medtrust is wholly owned by the Foundation and is a company registered in England and Wales. It is engaged in the exploitation of intellectual property rights.

In March 2011, the Foundation purchased 525,998 ordinary shares of Medtrust at £1 each to acquire 50% of the intellectual property rights of BMJ Quality & Safety, a journal published by the BMJ Publishing Group Limited. This social motive investment is held at cost in the charity balance sheet. Medtrust undertakes an impairment review each year.

At 31 December 2021, Medtrust had fixed assets of £526k (2020: £526k) and current assets of £237k (2020: £167k). The shareholders’ funds include called-up share capital of £526k (2020: £526k) and reserves of £237k (2020: £167k).

During the year, Medtrust had an operating profit of £236k (2020: £169k). The sum equivalent to its taxable profits will be donated to the Foundation, as provided for in Medtrust’s Articles of Association.

The Victoria Fund LP Incorporated (Victoria Fund)

The Victoria Fund was formed in February 2010 and is a limited partnership, number 1275, registered in Guernsey. Its purpose is to invest in a combination of hedge funds, private equity and private infrastructure. The limited partner is the Health Foundation and the general partner is Brook Street Limited, a Cayman Islands exempt limited company. Brook Street has delegated its powers to an investment manager, Cambridge Associates Limited.

As the limited partner, the Health Foundation is entitled to all investment returns less a priority share by the general partner (Brook Street Limited) from the Victoria Fund and, for consolidation purposes, it is treated as a wholly owned subsidiary of the Foundation.

As at 31 December 2021, the Victoria Fund had fixed asset investments of £397,172k (2020: £336,668k) and the value of its net assets was £401,368k (2020: 345,541k). Net profit in the year was £56,140k (2020: £54,665k).

98

27.0 Cash used by operations – Group

27.0 Cash used by operations – Group
2021
£’000		 2020
£’000
Net income for the year 112,757 52,685
Adjustments for:
Investment income recognised in statement of fnancial activities (15,638) (15,440)
Cost of raising funds 13,038 14,654
Fair value gains and losses on investments (149,068) (93,716)
Depreciation, amortisation and impairment of fxed assets 1,648 1,603
Movements in working capital:
(Decrease)/Increase in debtors 574 (1,214)
Decrease in creditors (8,906) (1,761)
Increase/(Decrease) in provisions (19) 20
Cash used by operations (45,614) (43,169)

28.0 Grant funding

The Foundation funded £16,599k of grants in 2021 (2020: £20,174k). These grants range from small one-off awards to multi-year demonstration projects and fellowships. Integral to all our award making is direct support from the Foundation, as well as technical expertise from technical providers and consultants. This support is organised and paid for by the Foundation, delivered directly to the award holders and can be in the form of technical development and assistance, learning events and coaching. Within this grant funding the Foundation also funds research and external evaluations to ensure programmes are evidence-based and offer value for money.

99

Grants made to organisations and individuals are analysed by strategic objective in the table below.

Lead recipient for Improving health and care services Total
£
Sheffeld Teaching Hospitals NHS Foundation Trust 499,500
Cambridge and Peterborough Foundation Trust 474,810
Bradford Teaching Hospitals NHS Foundation Trust 474,668
Manchester University NHS Foundation Trust 472,924
University Hospitals Dorset NHS Foundation Trust 435,215
Department of Health Income (HGC) 421,532
BMJ Group 164,060
NHS Providers 124,062
SSRS 102,042
Academy of Medical Sciences 99,915
Royal Cornwall Hospitals NHS Trust 99,400
University of Glasgow 98,925
Nuffeld Trust 65,832
Equal Care Co-op 60,000
Torbay Council 57,000
Community Hospitals Association 30,000
Gloucestershire Clinical Commissioning Group 30,000
Health Innovation Network 30,000
Kingston Hospital NHS Foundation Trust 30,000
LatchAid 30,000
Midlands Partnership Foundation Trust 30,000
Northern Health and Social Care Trust 30,000
Somerset NHS Foundation Trust 30,000
South Doc Services MyHealthcare Federation 30,000
Southern Health and Social Care Trust 30,000
St George’s NHS Foundation Trust 30,000
The Newcastle Hospitals NHS Foundation Trust 30,000
University College Dublin 30,000
University Hospital Southampton NHS Foundation Trust 30,000
West London NHS Trust 30,000
University of Bristol 29,995
Barts Health NHS Trust 29,993
Kent Surrey Sussex AHSN Limited 29,991
Southern Health NHS Foundation Trust 29,973
Centre for Sustainable Healthcare 29,918

100

Lead recipient for Improving health and care services Total
£
Southeastern Health and Social Care Trust 29,876
Oxford University Hospitals NHS Foundation Trust 9,785
North Bristol NHS Trust 29,674
Mid and South Essex Foundation Trust 29,600
Cambridge University Hospitals NHS Trust 29,286
University College London Hospitals NHS Foundation Trust 29,247
University Hospitals Dorset NHS Foundation Trust 28,875
Health Sciences Academy 27,940
University Hospitals of Leicester NHS Trust 26,554
Beautiful Information Ltd 25,000
Blackpool Teaching Hospitals NHS Foundation Trust – Blackpool, Lancashire 25,000
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust 25,000
East London NHS Foundation Trust 25,000
Mid and South Essex NHS Foundation Trust 25,000
NHS Greater Glasgow and Clyde 25,000
The Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust 24,050
NHS Forth Valley 20,931
Chelsea and Westminster Hospital NHS Foundation Trust 20,000
East Midlands Academic Health Sciences Network 20,000
South West Academic Health Science Network 20,000
Wessex Academic Health Science Network 20,000
West of England AHSN 20,000
Innovation Agency (Academic Health Science Network for North West Coast) 19,971
Yorkshire and Humber Partners Academic Health Science Network (trading as Yorkshire
& Humber Academy		 19,921
UCL Partners 19,899
South Tees Hospitals NHS Foundation Trust 19,747
Healthcare Improvement Scotland 19,366
The Oxford Academic Health Science Network 18,500
Newcastle-upon-Tyne Hospitals NHS Foundation Trust 18,493
UCL Research Department of Epidemiology and Public Health 15,000
Rammya Mathew 11,800
Health Innovation Network (HIN) South London 9,346

101

Lead recipient for Promotinghealthylives for all Total £
Improvement Service Scotland 550,000
Havant Borough Council 473,757
Liverpool City Region Combined Authority 465,900
Leeds City Council 439,502
Glasgow City Council 347,865
Fairshare Educational Foundation 208,888
University of Cambridge 166,599
Business for Health CIC 150,000
Salford City Council 98,337
SOLACE 96,029
Resolution Foundation 35,000
Lead recipient for Other(COVID-19grants) Total £
Children in Need 1,000,000
Comic Relief 1,000,000
UNICEF UK 200,000
Resolution Foundation 35,000
Grand Total 10,269,493
Adjustments to awards made in previous years 447,456
Services provided by third parties to support award holders and further the work of
the Foundation		 5,654,784
Grants and donations awarded to charities by governors 227,500
Total Grants 16,599,233

102

Appendix: Investment Fund Managers

Investment Fund Managers

BlackRock Investment Managers (UK) Ltd 12 Throgmorton Avenue Drapers Gardens London EC2N 2DL United Kingdom

Colchester Global Investors Heathcoat House 20 Savile Row London W1S 3PR United Kingdom

NinetyOne 55 Gresham Street London EC2V 7JD United Kingdom

River & Mercantile Asset Management LLP 30 Coleman Street London EC2R 5AL United Kingdom

Goldman Sachs Asset Management 25 Shoe Lane London EC4A 4AU United Kingdom

RWC Partners 10 Bressenden Place London SW1E 5DH United Kingdom

MFS Investment Management One Carter Lane London EC4V 5ER United Kingdom

Savills Investment Management LLP 33 Margaret Street London W1G 0JD United Kingdom

Mayfair Capital Investment Management 55 Wells Street London W1T 3PT United Kingdom

Mondrian Investment Partners Limited 10 Gresham Street London EC2V 7JD United Kingdom

Somerset Capital Management Manning House 22 Carlisle Place London SW1P 1JA United Kingdom

Antin Infrastructure Partners 374, rue Saint-Honoré 75001 Paris France

Apollo Global Management 9 West 57th Street 43rd Floor New York NY 10019 United States of America

103

Bessemer Venture Partners 889 Winslow St Suite 500 Redwood City CA 94063 United States of America

Brookfield infrastructure 462 South 4th Street, Suite 1600 Louisville KY 40202 United States of America

Cadian Capital Management LP 535 Madison Avenue 36th Floor New York NY 10022 United States of America

CBC Suite 4508, Tower 2, Plaza 66 1366 Nanjing West Road Shanghai 200040 China

Cortec Group 140 East 45th Street New York NY10017

Crescent Capital 100 Federal Street 31st Floor Boston MA 02110 United States of America

Cyrus Capital Partners, L.P. 65 East 55th Street 6th Floor New York NY 10022 United States of America

Davide Leone & Partners Investment Company LLP 9-10 Savile Row 3rd Floor London W1S 3PF United Kingdom

Electron Capital Partners 10 East 53rd Street 19th Floor New York NY 10022 United States of America

Element Capital Management LLC 600 Lexington Ave 34th Floor New York NY 10022 United States of America

Equilibrium One Bush Street Suite 525 San Francisco CA 94104 United States of America

General Atlantic Park Avenue Plaza 33rd Floor 55 East 52nd Street New York NY 10055 United States of America

Glennmont Partners Angel Court 13th Floor 1 Angel Court London EC2N 1HQ United Kingdom

104

Graham Capital Management 55 Baker Street Marylebone London W1U 8EW United Kingdom

Grantham, Mayo, Van Otterloo & Co. LLC 40 Rowes Wharf Boston MA 02110 United States of America

Greenspring Associates 100 Painters Mill Rd #700 Owings Mills MD 21117 United States of America

Harbourvest One Financial Harbor Boston MA 02111 United States of America

Hengistbury Investment Partners LLP 34 Brook Street London W1K 5DN United Kingdom

Investindustrial 16 Palace Street London SW1E 5JD United Kingdom

I Squared Capital 600 Brickell Avenue Penthouse Miami FL 33131 United States of America

Junto Offshore c/o Maples Corporate Services 450 Park Avenue New York NY 10022 United States of America

Laurion Capital Management LP 360 Madison Avenue Suite 1900 & 2000 New York NY 10017 United States of America

Level Equity 140 East 45th Street 42nd Floor New York NY 10017 United States of America

Lexington Capital Partners 660 Madison Avenue 23rd Floor New York NY 10065 United States of America

LGT Capital Partners Third Floor, 30 Herbert Street Dublin 2 Ireland

Lone Star Funds 12 Queen Anne Street London W1G 9LF United Kingdom

Mason Capital Management LLC 110 East 59th Street 30th Floor New York NY 10022 United States of America

105

Olympus Partners Metro Center 4th Floor One Station Place Stamford CT 06902 United States of America

Peak Rock Capital 13413 Galleria Circle, Suite Q-300 Austin TX 78738 United States of America

P/E Investments LLC 75 State Street 31st Floor Boston MA 02109 United States of America

Penta Investment Advisers Limited c/o Old Peak Ltd Level 27, Entertainment Building 30 Queen’s Road Central Hong Kong

Rubicon Suite 400 1911 11th Street Boulder CO 80302 United States of America

SV7 Impact Medicine Fund 71 Kings Way London WC2B 6ST United Kingdom

Sylebra Capital Management 28 Hennessy Road 20th Floor Hong Kong

Thoma Bravo 600 Montgomery Street 20th Floor San Francisco CA 94111 United States of America

True Ventures 501 3rd Street San Francisco CA 94107 United States of America

Vida Ventures 40 Broad Street, Suite 201 Boston MA 02109 United States

Vitruvian Partners 105 Wigmore Street London W1U 1QY United Kingdom

Star America Infrastructure Partners 165 Roslyn Road Roslyn Heights New York NY 11577 United States of America

Stonepeak Infrastructure Partners 717 5th Ave Ste 25 New York NY 10022 United States of America

106

The Health Foundation t +44 (0)20 7257 8000 e info@health.org.uk @HealthFdn www.health.org.uk

Registered charity number: 286967 Registered company number: 1714937 © 2022 The Health Foundation

108

Annual Report and Financial Statements_2021_ The_Health_Foundation

Final Audit Report

2022-07-26

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