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2024-12-31-accounts

Annual report and financial statements

For the year ended 31 December 2024

Contents

5 Introduction

9 2024: Year in review 10 Improving people’s health and reducing inequalities

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26 Looking ahead 28 29

Improving health and reducing inequalities Radical innovation and improvement in health and care

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32 Financial review and statements

3

Working to build a healthier UK

Introduction from the Chief Executive and Chair

Improving the nation’s health has never been more vital. The headlines in 2024 gave us a flavour of why, with the NHS remaining under immense pressure and the limp state of the UK economy prominent in the news. There were, of course, lots of reasons for this but a few stats jumped out: namely the 20% of the working-age population economically inactive, and the record-high number of 2.7 million people who put this down to chronic illness.

At the same time, the year saw significant political change with Sir Keir Starmer becoming the first Labour Prime Minister since 2010. Cue promises of change and national renewal, alongside a health mission to build ‘an NHS fit for the future’ and ‘a fairer Britain, where everyone lives well for longer’. Recognition of the priorities ahead, yes, but what of the solutions? Will Labour’s mission-driven approach to government mean durable changes for the longer term? And what about the huge potential of technologies in health and care, including AI – what are the priorities, do these innovations work as intended and how fast can the NHS and the public take them up?

The Health Foundation is uniquely placed to help understand and find solutions in this challenging context, to make a real difference for the people of the UK. Our endowment gives us ambition, independence, stability and freedom to think longer term – significant assets in today’s world. Our role in providing robust evidence and well-informed, independent analysis is essential as we take the opportunity to influence the decisions and priorities of the new government as well as other significant organisations and groups.

In 2024, we continued to be guided by our three strategic priorities:

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In each of the three areas we undertook a range of activities, from grantmaking, research and fellowships, to collaborating with stakeholders and working in partnership. The three areas bring together expertise from across the organisation, including analysis from our economists and data analysts.

Generating robust evidence and insight through our research and analysis remains central to our work. In 2024 we published several major outputs, allowing us to reach audiences, gain media traction and influence policy and practice. For example, our flagship report on projections of health inequalities across the population to 2040 received widespread media coverage and continues to be referenced by journalists, academics and policymakers. The report makes for sobering reading: on current trends, people in the 10% most deprived areas can expect to be diagnosed with major illness a decade earlier than people in the 10% least deprived areas over the next two decades. Ahead of the General Election, in June, we launched a series of four briefings looking at key aspects of the debate – from the need to move health prevention from rhetoric to reality, to projections of how much funding the NHS will need in the decade ahead. And we continued to build evidence on technology and AI in health care, including through our landmark event on the role of AI in shaping the future of the NHS.

In addition, we achieved impact through significant collaboration with other organisations. Health Equals continued to take its message to the public in 2024, bringing 27 member organisations together to deliver its highly successful Make Health Equal campaign. Our independent Commission for Healthier Working Lives published its interim report in October, seeking to build consensus on the actions needed by government and employers on growing challenge of working-age ill health. And both our Adopting Innovation and Common Ambition programmes ended in 2024, with learnings published from each of their evaluations.

Internally, we are developing the Foundation as an organisation – our people, operational and business processes, and our infrastructure. And across our external and internal priorities there are three vital cross-cutting themes. The first is environmental sustainability. Among other things we are using our responsible investment policy and our endowment to leverage more progress. The second is equity, diversity and inclusion – making this a focus across our external work, but also making progress internally to increase diversity

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and develop a more inclusive culture. And the third is public participation – reaching out more to the communities and groups we ultimately are here to serve, to make sure their experience and perspective more fully influences the work we do.

Our achievements in 2024 are due to the hard work and commitment of staff, governors and the people we work with across health and care. Together, we look forward to making progress in 2025 and beyond – always for the benefit of the UK population and, in particular, the most vulnerable in society.

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Dr Jennifer Dixon
Chief Executive
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Sir Hugh Taylor Chair

We announced on 25 June 2025 that Sir Hugh Taylor will be stepping down as Chair at the end of the month. I would like to thank him for the huge contribution he has made as Chair; the Foundation would not be where it is today without his advice and guidance. We have welcomed Sir David Behan to the board, and I look forward to working with him when he takes over as Chair in August 2025.

Dr Jennifer Dixon

Chief Executive

7

2024: Year in review

Improving people’s health and reducing inequalities

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Health is our most precious asset. It is shaped by the work we do, the income we earn, the education we receive and the places, communities and families we live in.

Improving health and reducing inequalities requires a whole-society approach – we cannot do this alone. We want decision makers across all parts of society to understand and fulfil their potential contribution to building a healthy nation.

Key highlights

Influencing government on a whole-government approach

to health : Health at the heart of government set out the mechanisms required across government to rebuild the nation’s health. These new ideas and a network of civil service contacts created a strong foundation for regular engagement, including brokering new relationships between the health mission and international experts, and sharing analysts our thinking on how to develop health targets with DHSC.

Supporting action to address the leading risk factors of ill

health : We published a report detailing policies to support local government action on tobacco, alcohol and unhealthy food. The policy recommendations formed the basis of an expert-led session with all staff at the Office for Health Improvement and Disparities, and discussed at our webinar with the Chief Medical Officer.

Developing new approaches to improving health through

economic activity : Practical learning from our Economies for Healthier Lives programme is supporting engagement with local, regional and central government. For example, the Glasgow City region developed a tool to assess the health impact of capital infrastructure spending in projects worth a combined £16bn.

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Raising awareness of health inequalities with the public : The

MakeHealthEqual campaign highlighted how the building blocks of health shape health inequalities. It achieved high levels of awareness and engagement with the public, including 930,000 website visits, 47 million chances to see (impressions) #MakeHealthEqual on Health Equals channels.

Providing insight on health inequalities across the nation :

Building on the success of the evidence hub, the local authority dashboard provides key indicators and analysis of health

inequalities and determinants of health. It continues to have high levels of engagement and is being used by local government as a tool to understand health inequalities in their area.

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Case study Influencing government by highlighting patterns of inequalities

Our report, Health inequalities in 2040, is one of the first studies of its kind. The research unpacks patterns of inequalities in diagnosed illness by socioeconomic deprivation across England, and projects them almost two decades into the future.

The research projects that stark inequalities will persist up to 2040, with profound implications for people’s quality of life, their ability to work and for the wider economy. The report also finds that health inequality is largely due to a small group of long-term conditions, with chronic pain, type 2 diabetes, and anxiety and depression projected to increase at a faster rate in the most deprived areas.

The report had strong media coverage and was featured on BBC Newsnight, the Today programme and BBC News. The work has also been extensively presented to senior stakeholders in government. It was mentioned in Wes Streeting’s keynote speech on the future of health and medicine during the Royal College of Physicians annual conference and referenced in proposals in the Get Britain Working White Paper. Engagement has subsequently led to discussions and influencing with OHID, the DHSC Strategy Unit, NHS England and Local Government associations.

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Supporting radical innovation and improvement in health and care services

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Innovation and improvement are more important than ever to ensure that health and care services meet people’s needs now and in the future.

We want to give policymakers, system leaders, service providers, health care staff, service users and the public the insights, practical resources and opportunities needed to support the far-reaching shifts needed in health and care over the coming decade.

Key highlights

Increasing awareness of tech attitudes and opportunities : Our

long reads on technology and time for care and roundtable event had great engagement, building strong relationships with a range of professional bodies. We have received feedback that our research is influencing thinking at the highest levels, including NHS England and the Treasury.

Developing resources to strengthen improvement capability :

THIS Institute’s Cambridge Elements series on improving quality and safety in health care offers authoritative overviews of major improvement approaches, from supply chain management to leadership and governance. The series has already had over 100k downloads and has been commended as a resource by NHS England.

Supporting the wider ecosystem to tackle health inequalities :

Q supported several NHS partners to tackle health inequalities and significantly improve wait times as part of broader transformational goals. 2023/24 Q Labs helped the Stockport NHS Foundation Trust team to reduce wait times in their pain management service from 240 days to 16 days, and found that patients, on average, reduced their opioid dose by 44%.

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Building influence through IMPACT : IMPACT is a UK-wide

centre for implementing evidence in adult social care. In 2024, it successfully made policy contributions to facilitate evidenceinformed change. Examples include serving as a special adviser to the House of Lords Adult Social Care Committee; being appointed to a working group producing the forthcoming 10-Year Health Plan; and joining key strategic groups across the devolved nations. IMPACT highlights its value by often being the only research-based organisation contributing to these discussions with a view of health and care across the UK.

Supporting new collaboratives in communities : Common

Ambition, a Health Foundation funding programme, ended in 2024. Through this programme, we were able to demonstrate the value of community driven change and generate insight on how to involve communities in improving services. In Bristol, work to build trust with the communities of Black and Caribbean heritage revealed that current HIV services did not feel safe. In response, Common Ambition Bristol set up a dedicated HIV testing clinic. This led to increased testing rates and treatment, a second clinic opening, and learning shared across the UK.

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Case study

Leading the conversation on AI

The role of AI in health care was a key topic in policy debates during the year. We highlighted important issues to consider in developing a new AI strategy for the NHS and positioned the Foundation as a leader in the space. There were three main aspects to this.

for a national AI health care strategy called for a coordinated approach to realise the benefits of AI at scale. It gained the most engagement of all general election content, helping to secure commitment from DHSC and NHS England that they will develop an AI strategy, which we are actively influencing.

one of the largest of its kind in the world, received widespread media coverage and revealed new insights into public and staff sentiment on AI. Policymakers and leaders have told us these are helping to shape thinking on future policy around AI.

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Providing evidence and analysis to improve health and care policy

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We want to see policy decisions on health and social care informed by the best available evidence and analysis, to improve the health system now and for the future.

Key highlights

Leveraging our independence to explore solutions for general

practice : Our Future of General Practice Symposium convened a wide range of experts to discuss the big questions facing general practice and collaborate to find solutions. Following the symposium, we provided briefings on themes with key policymakers, providing an important platform for ongoing influencing.

Using our experience and engagement to influence 10-Year

Health Plan : We published major research on The public’s views on the future of the NHS that gave unique insights into the public’s views on the trade-offs and big reform questions facing any new government. Publishing just before the election was announced enhanced our impact, with briefings given to the main political parties, Department of Health and Social Care and NHS England. The Financial Times published the findings as an exclusive and almost 900 people watched our webinar live.

Increasing engagement through expert analysis : We published

How much funding does the NHS need over the next decade ahead of the election, enabling us to better hold political parties to account when debating NHS funding. Our analysis contributed to evidence-informed debate and was covered twice on the Today programme, as well as in the Financial Times, The Times, Guardian, Politico, Mail and the Independent.

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Using new and immersive engagement to build understanding :

The NHS has a target to reach net zero by 2045 but achieving this will be challenging. To facilitate engagement, discussion and action, we created an immersive installation of a 2036

net-zero NHS showing the opportunities and trade-offs involved. More than 500 people from government, NHS England and elsewhere have engaged with the installation so far.

Informing national discussions and policy to improve the NHS

waiting list : Our analysis into waiting list pledges generated significant reach, including coverage by BBC Newsnight (January), the Today programme (March) and in The Times. During the election, our insights on Labour’s manifesto waiting list goal was covered on Radio 4’s More or less programme and in the Guardian. This work has put us in a strong position to feed into policy discussions with stakeholders and lays the foundations for our 2025 work on waiting lists.

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Case study

Developing the strength of networks to tackle complex challenges

Sciana Health Leaders Network has grown in size and strength over the past 2 years. There are now over 100 fellows from the UK, Germany and Switzerland with backgrounds in public health, health and care providers, academics, government, and more. The network aims to develop the collaborative leadership skills and policy knowledge to tackle the complex challenges facing health systems, including tech and AI, as well as reducing inequalities in health across Europe through a 2-year leadership programme.

In 2023, an evaluation found that Sciana was highly valued by fellows, particularly the residential meetings and wider network events, such as a summit at the OECD on digital transformation. Several UK fellows have moved into positions of influence, expanding the Health Foundation’s network and reach.

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Work to improve the Foundation

As well as adapting and improving what we do, we’re also focusing on how we do it. The Health Foundation has grown in recent years and is now an organisation of 284 employees. We take our role as an independent charitable organisation seriously, and we’re doing lots to improve our day-to-day activities.

Key highlights

Improving policies, processes and practices to support strategic decision making and ensure business behaviours are aligned to Sustainable Development Goals.

Ensuring long-term financial stability through the creation of our long-term financial sustainability plan, delivering our first full internal audit programme, resulting in a positive audit opinion for the Foundation for the first time for 2024, and reviewing financial policies.

Developing our capabilities as both an organisation and as a pool of talent, helping to allow us to operate more efficiently and effectively going forward.

Enabling a more factual discourse and evidence-based debate on health and care during the general election, generating new content and increasing engagement with our work.

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Case study

Working cross-organisationally for the general election

We know from the impact of our external work and from internal surveys that we achieve more when we work together. An example of this was our internal collaboration to enable a more factual and evidence-based debate about issues in health and care during the 2024 general election. Months before the election was called we had set up a team from across the organisation – including policy experts, communications professionals, data analysts and more – to devise a programme of content. We also engaged externally with the main political parties' policy thinking and manifesto development, including a presentation to Wes Streeting and the Labour health team on our public polling and deliberative research.

The election was called earlier than expected. Therefore during the 6-week campaign period, we quickly reorganised our work around five key themes, set up new ways of working with representatives from across teams and significantly ramped up external activity.

By working together, we were able to meet regularly and work flexibly and at pace. One particularly impactful piece of work, the REAL Centre’s NHS funding projections, secured widespread print, online and broadcast coverage and has been widely cited. We also produced an analysis of the main parties’ manifestos and responded to key aspects of the public debate through our blogs, externally placed articles and media coverage that often exceeded benchmarks. During the period, we published 10 new pieces of long-form content and 20 blogs. These outputs drove a high volume of traffic to our website and helped build our brand and reputation for evidence-based insights.

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Cross-cutting themes

We have made progress in our cross-cutting themes of equity, diversity and inclusion (EDI), environmental sustainability and public participation. We know these themes are very important to our staff and our stakeholders alike, and we are working to embed these in all our activities externally and internally.

Equality, diversity and inclusion

In 2024, we developed a 3-year EDI strategy that sets the direction for our work on EDI and priorities for action as an employer, a funder and a brand. It covers the range of our work at the Foundation – who we are, how we work and what we do – and identifies the changes we want to make to become more diverse, inclusive and equitable.

This has set the foundation for us to ensure that health equity is at the heart of what we do. The strategy is accompanied by a detailed action plan for year one that sets out how the strategy will be delivered, how progress will be measured and who will be responsible for overseeing progress across the whole strategy.

This builds on work of supporting staff networks, establishing a People Forum and links to our work on public participation.

Public participation

Public participation ensures our work remains relevant and responsive. In 2024, we created three new public participation roles to lead on different aspects of this work. They have created drop-in sessions for staff to connect different areas of work and share learning, and held training sessions.

Our approach to public engagement and involvement has also been strengthened by our EDI strategy work, which builds on work to boost our focus on health inequalities in our research, analysis and funding.

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Environmental stability

We have improved practices to increase endowment investments aligned to Sustainable Development Goal 3 on climate action (SDG 3) and Sustainable Development Goal 13 on good health and wellbeing (SDG 13), making £12m investment whose objectives meet these goals:

Almost two-thirds of actively managed public equity companies have committed targets or have targets approved by the Science-based Target Initiative against SDG 13, an increase of 23% by portfolio weight of companies with approved targets from 2023. Against SDG 3, a third of companies report business activities linked to positive outcomes, consistent with 2023.

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Looking ahead to 2025 26

With ongoing pressures on health and care likely to dominate the policy agenda, as well as a challenging and uncertain economic context, we know making progress will be hard. In this context, we will develop and communicate work in areas where our expertise can help most – such as NHS productivity, working-age health and digital innovation – using our communications to maximise reach, profile and impact.

In the year ahead we will also be developing a new strategic plan covering 5 years from 2026. This will help to set our priorities for the longer term, including how we can be more impactful given our investment income. To help inform our thinking, we’ll be in touch with many of you to understand your views about how we can have the most impact.

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Improving health and reducing inequalities

Health is an asset to our society and our economy. We will continue to make this case through our in-house analysis, the Commission for Healthier Working Lives and our communications activities. We want our stakeholders to use our evidence and messaging to inform influencing activities and decision making.

z[We will conclude our 18-month ] national Commission for Healthier Working Lives in the spring before beginning the action phase. The Commission will set out recommendations, principally for government and employers, on how to support people to stay in work rather than becoming economically inactive due to ill health.

z[Our analysis of health inequalities ] and what to do about them will continue, including with our funded Scottish Health Equity Research Unit. We will make the case for ringfenced government health spending on prevention,

and for prevention accounting at national and local level through partnerships with Demos, CIPFA and our work on risk factor policies.

z[We will publish a joint report with ] the Runnymede Trust looking at how racism affects people’s health. This will look at the large and unacceptable variations in people’s experiences of three key building blocks of health – employment, wealth and the lived environment – and how these vary by ethnicity.

z[We will share learnings from ] ShareAction’s Long-term Investors in People’s Health (LIPH) programme, supported by the Health Foundation. In recognition that most investors are overlooking health as an ESG (environmental, social and governance) issue, the programme aims to give investors the tools to improve health outcomes for workers, consumers and communities, by sharing best practice.

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Radical innovation and improvement in health and care

2025 will see us further bedding in our focus on technology and innovation, while maintaining and strengthening our established reputation on improvement.

z[AI, technology and digitisation ] have the potential to reshape health and social care, improve productivity and ease workforce pressures. As well as convening, events and thought leadership, we will publish research on the digital foundations required – including estimating the cost of digitising the NHS and social care – to bring services into the 21st century.

z[We will continue to be a ] prominent voice and influence on improvement in the UK. Through Q, we will demonstrate new approaches to improvement across local care systems, including through our partnerships with the NHS Confederation and NHS Providers. And we will help to shape the 10-Year Health Plan for the NHS on technology and the role of quality improvement.

z[We will be drawing on our assets, ] including our Improvement Analytics Unit, THIS Institute and Thiscovery digital research platform in Cambridge. We will be focusing on formative evaluation to help improve the use of technology as it is being tested, using quantitative and qualitative methods as well as a quality improvement methods to support progress.

z[We will be developing our policy ] work on artificial intelligence – helping to think through what the most effective strategy will be for health care – as well as developing our offer (funding and in-house) to evaluate technologies robustly and rapidly.

z[We are also developing several ] programmes around the use of technology and AI in health and care. In 2025, we will be launching a programme to support the spread of technology empowered service change, as well as expanding our support for AI in non-clinical settings.

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Evidence and analysis to improve health and care policy

We will continue to work under the seven themes identified in our 2023–25 strategy: health system performance, NHS reform, social care, primary care, funding and finance, workforce, and efficiency. We have refined our objectives for 2025 and developed plans that build on and expand our work in these areas.

z[We will continue a variety ] of international comparative analyses on performance and system reforms, not least through our co-funding of the WHO Observatory on health systems covering the WHO European region.

z[We will also build leadership ] capability in health and care by continuing to co-fund the Harkness Fellowship programme (US oriented) and the Sciana leaders programme (a network of leaders from Germany, Switzerland and the UK).

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Work to improve the Foundation

During 2025, we will launch a Future Foundation programme to ensure that our operating model, people, culture, and systems and processes will deliver the requirements of the upcoming 5-year strategy.

We will also progress with our three cross-cutting themes.

z [Equity, diversity and inclusion:]

During 2025 our focus turns to delivering the year one action plan to ensure we deliver against the strategy developed in 2024, and developing the action plan for year two so we become more diverse, inclusive and equitable.

z [Public participation:][ Public ] participation ensures our work remains relevant and responsive. In 2025, the public participation leads will be facilitating workshops with each directorate to clarify our collective understanding of public participation in the Foundation, discover what’s already happening and showcase this, raise awareness of resources available to people, understand what more would be helpful and generate momentum for public participation work. These workshops will help shape the direction of the public participation leads’ work and priorities for the remainder of 2025.

z [Environmental sustainability:][ We ]

will continue our work to become a greener organisation that is fit for the future. This means continuing to change the way we invest our endowment, manage our office, procure goods and services, distribute our funding and more.

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Financial review and statements

32 Financial review and statements

Legal and administrative information

Governors

Sir Hugh Taylor (Chair) (to 31 July 2025) Sir David Behan (from 9 July 2025)* Katie Blacklock Dawn Edge Ravi Gurumurthy Eric Gregory (to 30 June 2025) Loraine Hawkins Ruth Hussey Branwen Jeffreys (to 11 July 2024) Paul Najsarek Roland Sinker David Smart Rosalind Smyth (to 17 July 2025) Rachel Sylvester (from 20 June 2024)

Charity number

286967

Investment Fund Managers

See Appendix

Company number

01714937

Registered office

8 Salisbury Square London EC4Y 8AP

Custodian and Performance Measurement

Northern Trust 50 Bank Street Canary Wharf London E14 5NT

External Auditor

Investment Advisers

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

Solicitors

Bates Wells 10 Queen Street Place London EC4R 1BE

Cambridge Associates Limited 62 Buckingham Gate London SW1E 6AJ

Redington 6th Floor 1 Angel Court London EC2R 7HJ

Financial review and statements 33

Charitable activities in 2024

Our charitable expenditure

As well as adapting and improving what we do, we’re also concentrating on how we do it. The Health Foundation has grown in recent years and is now an organisation of approximately 280 people. We take our role as an independent charitable organisation seriously, and we’re doing lots to improve our day-to-day activities. During 2024, we continued with our organisational improvement programme to build the Foundation of the future across strategic planning, programme management, people, finance, grants and awards and supporting technology systems. This programme will continue to deliver benefits in 2025, where we look more closely at our target operating model and how our funding supports that.

Our charitable expenditure is made up of:

Our charitable expenditure of £50.4m is illustrated in the chart below; the outer circle shows the split by strategic priority, with the inner circle split as described above.

34 Financial review and statements

Figure 1: Charitable expenditure in 2024

33[%] 42[%] 25[%] Grant funding Direct Support and of activities costs governance costs £16.5m £21.2m £12.7m

9[%] Cross cutting strategic activities £4.6m

28[%] Improving people’s health and reducing inequalities £14.1m

53[%] Supporting radical innovation and improvement in health and care services £26.5m

10[%] Providing evidence and analysis to improve health and care policy £5.2m

Financial review and statements 35

2024 was the second year delivering our 3-year strategy. Charitable spend is allocated to our three strategic priorities. Our charitable expenditure of £50.4m compares to £47.8m in 2023, the key movements over £0.6m were:

health and care services grant spending was £2.8m more than prior year, including £1.7m on the new Tech For Better Care programme (new in 2024) and £0.7m more invested in the Networked Data Lab. In addition, there was £0.6m increased expenditure through THIS Labs subsidiary as it was operating for a full year and a proportional increase in cost allocation as grant spending in other areas decreased, increasing overall investment by £10.0m.

and care policy grant spending was £1.2m less driven by the 2023 recommitment of £0.8m to the Harkness Fellowship programme with The Commonwealth Fund. Overall, the investment was £2.5m less as the cost allocation was lower based on the reduced grant spend.

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 2024, we received £14.9m investment income and transferred £33.0m of capital from the endowment, in line with our expenditure policy.

We received restricted income of £1.7m (2023: £1.6m) 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 improvement and innovation capability.

36 Financial review and statements

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, with the exception of THIS Institute. 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.

Financial review and statements 37

Our investments

Investment policy and strategy

The board of governors have recently reaffirmed their commitment to run the Foundation as a permanent institution so the endowment, while technically expendable, is treated as if in perpetuity to support the operations of the Foundation over the very long term. Therefore, apart for the need to retain a degree of near-term liquidity in order to fund the nearer term operations, the emphasis is on achieving a substantial long-term real rate of return of 4% over inflation, measured by the Consumer Price Index. The aim is for the real value of the endowment to be preserved over the long term allowing for 4% per annum distributions to fund operations.

At the beginning of 2025, a revised methodology used to calculate annual expenditure was approved by the governors on the recommendation of the Investment Committee. The exisitng method of calculating distributions did not allow for any inflationary increase in the operational expenditure of the Foundation and did not allow for sufficient long-term smoothing of the value of the endowment. The formula used by Yale University and adopted by many endowments over many decades was considered most appropriate to accomodate for these factors. Specifically, the Yale endowment spending policy as we are applying it in the Foundation is a weighted calculation of 30% of the endowment value 2 years prior and 70% of prior year spending, adjusted by prior year inflation. The methodology uses an agreed spending rate of 4% to provide the right balance between long-term sustainability and short-term needs of the Foundation.

The endowment has a structured investment process consisting of two primary features:

38 Financial review and statements

Nine investment beliefs developed by the governors were updated in March 2025. These provide a framework for accountability across all investmentrelated activities and decision making.

  1. Governance We maintain a high level of governance to manage a large endowment, investing across a set of globally diversified assets.

  2. Investment objective Our long-term return objective is set at CPI+4%, supporting the long-term sustainability of the endowment.

  3. Achieving risk-adjusted returns Alongside monetary assets, we invest in liquid growth assets in the belief that over the long-term they will produce sufficient returns above inflation to meet our target return. Over the long-term an allocation to illiquid growth assets will be additive to those returns.

  4. Inflation dynamics We recognise that inflation poses a significant risk to the endowment achieving the real return target over the long-term.

  5. Managing capital loss: risk tolerance and diversification By embedding a risk tolerance of 20% 1-year 95 Value at Risk, we aim to manage short-term drawdown risk while pursuing long-term growth objectives.

  6. Liquidity requirements We ensure that at least 2 years of operating budget is maintained in cash and high-quality short-dated bonds.

  7. Active management Financial markets are not always efficient, presenting opportunities for skilled active investment managers to achieve returns that exceed those of the broader market.

  8. Responsible investment Operating through a dual lens allows us to jointly consider financial return and responsible ownership.

  9. Investing for net positive outcomes Long-term investments in strategies that demonstrate measurable and net positive outcomes across nature-based and health systems can generate risk-adjusted market returns and help us deliver impact against our sustainability goals.

The Investment Committee reviews performance and the invesment risk management framework, in addition to revieiwng the long-term investment strategy and monitoring progress on its implementation. We are long term investors and, as such, whilst we monitor the strategic asset allocation quarterly we do not carry out short-term tactical readjustments to asset class weightings.

Financial review and statements 39

The in-house investment team manage the endowment on a day-to-day basis, implementing strategic asset allocation and monitoring all performance, risk metrics and portfolio holdings. Redington is the 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 alternative asset classes.

Our approach to responsible investment

The governors recognise that business activities that cannot be sustained environmentally or socially will naturally give rise to risks, and these may be financially material. However, companies that operate responsibly across environmental, social and governance factors produce superior long-term returns, benefiting both investors and society through sustainable practices. To ensure the long-term sustainability of the endowment’s investments, and consistent with the duty to act in the best financial interests of the Foundation, the governors seek to avoid those risks and capitalise on long-term opportunities through a good understanding of how material sustainability issues impact the endowment.

Responsible investment approaches are integrated across all investmentrelated activities guided by two sustainability ambitions:

Four responsible investment guiding principles have been developed, and updated in 2025, to provide the endowment’s investment strategy with an overarching framework to strengthen responsible investing and stewardship credentials and seek to ensure the right balance between delivering the financial return target required to fund the Foundation, alignment with the Foundation’s mission and values, and an understanding of the reputational risk associated with both actions and inactions.

40 Financial review and statements

In practice, our approach to responsible investment involves the effective integration of environmental, social, governance (ESG) factors into decision-making, and stewardship activities, such as engagement, collaboration and voting practices. The objective is to promote long-term sustainable value creation through the oversight of managers and companies owned to guide better real-world sustainable business outcomes. We require all our investment managers to demonstrate leadership in ESG integration and reporting, 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 funds and should a stock appear 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 governors.

The Health Foundation is a member of the Charities Responsible Investment Network and maintains dialogue with investor coalitions such as Longterm Investors in People’s Helath, Institutional Investors Group on Climate Change and Good Work Initiatives.

Financial review and statements 41

Investment returns

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

In 2024 the endowment returned 8.7%, outperforming the target performance of 6.5% (CPI+4%). During the year, public equity markets performed strongly led by the US, which continued to benefit from its high concentration of technology stocks. Private equity and venture capital lagged public equity markets, reversing some of the exceptional gains during the COVID-19 period. However, global markets have experienced a much more challenging environment during the first few months of 2025, as US tariffs have caused substantial market volatility. Recent IMF forecasts suggest global growth will be at least 0.5% lower this year, with risk to the downside and growth assets set to face a challenging period for returns.

Figure 2 shows the change in the value of the investments. In 2024, the value of the investments increased by £46m, from, £1,196m to £1,242m.

Strategic Asset Allocation

During 2024, the strategic asset allocation was reviewed according with the scheduled 3-year review cycle. Notably, the decision was taken to withdraw from hedge fund assets and increase allocations to ‘near cash’ assets (high quality UK gilts) and initiate an allocation to investing in alternative impact investment funds which clearly demonstrate net positive outcomes across society and nature-based systems. Implementation of these changes began towards the end of 2024. See Figure 3.

The flexibility exists to increase the liquidity (cash) buffer within the endowment to ensure that the spending needs of the Foundation can be met. As such, by the end of 2024 the total of cash and ‘near cash’ assets reached 2 years of expenditure.

Early in 2025 global financial markets experienced volatility following the announcement of US trade tariffs. Endowment public equity valuations were impacted during this period, however in line with expectations due to the diversified nature of the investments. By the end of April 2025 asset valuations had somewhat recovered. The Investment Committee held an extraordinary meeting in April to review the endowment valuation and

42 Financial review and statements

strategic asset allocation. The Investment Committee agreed to increase cash and ‘near cash’ assets to three years of expenditure to ensure the endowment maintains enough liquidity to fund the Foundation’s plans for the foreseeable future. It remains appropriate for the endowment to tolerate periods of market volatility and maintain an allocation to growth assets, such as public equity and private equity strategies, to provide the required level of sustainable returns, CPI+4%.

Figure 2: Investment values as at 31 December 2024

----- Start of picture text -----
£1,400m
£1,231m £1,242m
£1,177m £1,196m
£1,200m £1,125m
£1,076m
£1,039m
£966m £980m
£1,000m
£800m
£600m
£400m
£200m
£m
2016 2017 2018 2019 2020 2021 2022 2023 2024
----- End of picture text -----

Figure 3: Comparison of the asset allocation 31 December 2024 to 2023 and target asset allocation*

----- Start of picture text -----
Listed equities Alternative assets Property and infrastructure
Fixed income strategies Cash and near cash Impact
2024 53% 25% 11% 7% 4%
1%
Target 57% 18% 8% 12% 4%
2023 52% 26% 12% 3% 7%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
----- End of picture text -----

*The Target Strategic Asset Allocation (SAA) was agreed end-2024 for implementation in 2025. The Target SAA acts as a guide to inform future investment allocations, where deviations from this target can occur due to adjustments in market valuations and revised allocations due to the market environment. The difference in the Alternative assets’ allocation is due to a change in the future allocation, notably the removal of Hedge Funds.

Financial review and statements 43

The total cost of managing our investments was £16.9m (2023: £14.9m). The increase was driven by strong public equity performance and increased alternative asset performance fees, and further details can be found in note 6.

Subsidiary companies

At the end of 2024, the Foundation had three subsidiary undertakings Medtrust Innovations Limited (Medtrust), the Victoria Fund LP Incorporated (Victoria Fund) and THIS Labs Ltd (THIS Labs).

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 2024, Medtrust had fixed assets of £0.5m (2023: £0.5m). In the year, Medtrust generated an operating profit of £0.2m (2023: £0.1m).

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 2024, the Victoria Fund had investment assets of £392m (2023: £433m) and the value of its net assets was £395m (2023: £437m). The net decrease in the value for 2024 was £42m (2023: £7m increase) was mainly due to the sale of hedge funds and transfers of cash to the charity totalling £63m, adjusting for this Victoria Fund made a £22m gain in 2024.

The Health Foundation set up a third subsidiary, THIS Labs which has been set up to enable improvement and innovation in the health and care sector through online collaboration with an initial investment of £4m to achieve these goals made in 2023. As at the end of the year the value of the net assets of THIS Labs was £1.4m (2023: £3.3m) as the team continue to invest in staffing and developing the platform to demonstrate its value in supporting collaborative approaches to research and consultation.

44 Financial review and statements

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 2024 Government guidance on the Streamlined Energy and Carbon Reporting (SECR) regime.

The enegy the Foundation consumed reduced slightly to approximately 583,065 Kwh in 2024 (2023: 602,468 Kwh) and CO2 emissions increased to an estimated 131.63 tonnes (2023: 126.12 tonnes) due to increased travel. Our intensity ratio is 0.055 tonne per square metre of our office space (2023: 0.052 tonne per square metre).

Electricity and gas – office

During 2024, our office electric energy consumption equated to 446,772 Kwh (2023: 462,786 Kwh) or 91.56 tCO2e (2023: 89.49 tCO2e). The electricity consumption has decreased slightly in 2024 while the emmission has slightly increased due to the increase in emmission conversion factors, while our office gas energy consumption remained relatively stable at 136,293 Kwh (2023: 139,682 Kwh) or 24.88 tCO2e (2023: 25.50 tCO2e). Electricity costs are partly metered and partly apportioned 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 2024 all types of travel continued to increase as travel habits continue to change after the pandemic, therefore travel journeys paid for directly by the Foundation equated to 143,970 miles (2023: 108,971 miles) or 15.19 tCO2e (2023: 11.13 tCO2e). Travel to and from Foundation events by external participants and attendees are not included in these calculations for both years.

Financial review and statements 45

Commitments and reporting

Environmental sustainability is a cross-cutting priority within the Foundation’s 2023–25 strategy, and we are committed to understanding and reducing our environmental impact. We have set the target of making our endowment net zero by 2035, with the interim target of halving the carbon emissions of the endowment by 2028. In 2024, we developed a long-term carbon reduction strategy and action plan for the rest of our operations, beyond the endowment.

2024 carbon reporting figures Mileage Consumption
kwh		 Carbon
emission
tCO2e
Scope 2
Health Foundation office – gas 136,293 24.88
Health Foundation office – electricity 446,772 91.56
Scope 3
Employee mileage personal cars 300 0.05
Travel – taxis 1,530 0.23
Travel – public transport 87,540 4.57
Travel – air 54,600 10.34
Total gross emissions in tonnes CO2e 143,970 583,065 131.63
Intensity ratio: tonnes CO2e per sqm 0.055
2023 carbon reporting figures Mileage Consumption
kwh		 Carbon
emission
tCO2e
Scope 2
Health Foundation office – gas 139,682 25.50
Health Foundation office – electricity 462,786 89.49
Scope 3
Employee mileage personal cars 2,417 0.64
Travel – taxis 202 0.05
Travel – public transport 70,372 3.65
Travel – air 35,980 6.79
Total gross emissions in tonnes CO2e 108,971 602,468 126.12
Intensity ratio: tonnes CO2e per sqm 0.052

46 Financial review and statements

Stakeholder engagement – s.172 statement

The Health Foundation’s board recognises the critical importance of its relationships with our key stakeholders to achieve its mission of building a healthier UK. To achieve our mission we need build and maintain collaborative relationships with a wide range of stakeholders.

We conduct regular perceptions surveys of our core stakeholders, which feeds into the development and delivery of our strategy plan (planned 2025).

National government, policymakers

We build evidence by conducting, commissioning and mobilising the highest quality research and analysis. We use this evidence – and our independence – to shape policy and practice by influencing and working with people working within national, regional and local government.

Examples from 2024 : Ahead of the General Election, in June, we launched a series of four briefings looking at key aspects of the debate – from the need to move health prevention from rhetoric to reality, to projections of how much funding the NHS will need in the decade ahead, enabling us to better hold political parties to account. We highlighted important issues to consider in developing a new AI strategy for the NHS and positioned the Foundation as a leader in the space. Our report, Health inequalities in 2040 , led to discussions and influencing with OHID, the DHSC Strategy Unit, NHS England and Local Government Association.

People working across the health, care and

wider system

We encourage long-term thinking and work with stakeholders including health and care organisations, other public services, investors, businesses and communities. We use our evidence, insights to promote improvements to health and other public services. We encourage and spread innovation and support new initiatives where a large-scale, long-term focus is needed to make a difference and lead networks for service improvement and learning.

Financial review and statements 47

Examples from 2024 : the Foundation’s Q Community, made up of thousands of people across the UK and Ireland, is continuing collaborating to improve the safety and quality of health and care. Practical learning from teams from our Economies for Healthier Lives programme is supporting engagement with local, regional and central government.

Our beneficiaries

The Foundation’s beneficiaries include the public, people working across the health and care system, researchers and academics and organisations receiving grants. To maximise the impact of our work we share our evidence across employs various communication channels such as webinars, podcasts, publications, blogs, newsletters, and social media. We aim to maximise the effectiveness of supported programmes and projects by managing our awards. We build skills, knowledge and capability by supporting people and organisations, including through, partnerships, fellowship programmes, networks and events.

Examples from 2024 : We support Health Equals and their public-facing #MakeHealthEqual campaign highlighted how the building blocks shape health inequalities. Common Ambition, a Health Foundation funding programme demonstrated the value of community driven change and generate insight on how to involve communities in improving health services. 2023/24 Q Labs helped the Stockport NHS Foundation Trust team to reduce wait times in their pain management service.

Our employees

Our employees’ skills, experience and understanding of our strategy are key for delivering our mission. We aim to create an inclusive and diverse organisation with high employee satisfaction and motivation and where people are supported to develop and grow.

We have in place approaches wellbeing, health and safety, support for staff-led peer networks, a people forum, an EDI strategy and action plan and comprehensive learning and development programmes.

48 Financial review and statements

Examples from 2024 : we saw significant expansion of our learning and development opportunities, a suite of EDI initiatives, and enhancements to recruitment approaches. We also help colleagues understand our strategy and organisational development work through our regular staff meetings, intranet and our annual ‘colleagues conference’, which featured a range of speakers from across our work and organisation to bring our strategy to life.

Our partners and other advocates

Through sharing what we learn and collaborating with others, we aim to make a difference and contribute to a healthier population. We engage with others working in health and on the wider determinants of health, meeting regularly across levels of seniority to share ideas and working together on pieces of work to maximise impact.

Examples from 2024 : Our independent Commission for Healthier Working Lives published its interim report in October, seeking to build consensus on the actions needed by government and employers on growing challenge of working-age ill health The Sciana Network is supported by a partnership between the Health Foundation (UK), Careum Stiftung (Switzerland) and the Robert Bosch Stiftung (Germany) in collaboration with Salzburg Global Seminar. Over 100 fellows – including from public health, health and care, universities, government – have explored the big issues facing our health today and in the future. IMPACT is a UK-wide centre for implementing evidence in adult social care. In 2024, it successfully made policy contributions to facilitate evidence-informed change.

Suppliers

The Foundation’s suppliers, including investment managers, are expected to operate ethically and provide value for money. As an accredited living wage employer, the Foundation aims to ensures contracted staff earn at least the real living wage.

Highlights for 2024 : We continued to engage with our investment managers particularly on ethical and social reporting and management, the Foundation developed new templates to support its focus on equity, diversity, inclusion, and sustainability through suppliers.

Financial review and statements 49

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 members of the senior leadership team.

The Audit Committee gives direction and reviews the implementation of the risk management process supported by an internal audit plan. Detailed below were the most important risks for 2024.

Key risk 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
insufficient liquidity.		 The Investment Committee ensures that the
Foundation’s investments are suitably diversified,
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. In the last year this has been enhanced
by a new requirement in the most recently completed
Strategic Asset Allocation that 2 years’ expenditure be
retained in a liquidity buffer invested in cash or short
term high quality bonds.
In 2024 public equity markets performed strongly led
by the US, which continued to benefit from its high
technology exposure. Private equity and venture lagged
reversing some of the exceptional gains during the
COVID-19 period.
In April 2025, however, the US has experienced a much
more challenging environment as President Trump’s
tariffs have caused substantial volatility. Recent
IMF forecasts suggest global growth will be at least
0.5% lower this year with risk to the downside. The
endowment has the flexibiity to increase its defensive
liquidity buffer and had already built this up above
2 years and is currently close to 3 years’ expenditure.
Nevertheless, it remains appropriate for a long-term
fund such as this to tolerate such volatility in seeking a
higher sustainable return of CPI plus 4%.
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 2024, we balanced continuing to implement our
2023–2025 strategy, with short-term policy influencing
work ahead of the general election.
Board oversight continues with quarterly oversight
of yearly business planning and impact reporting
of prior year outcome. Each board meeting has an
informal strategy session and initiatives with strategic
importance have a board member sponsor who attends
the annual review of their initiave.
As we continue our work on the current strategy and
engaging the new government, 2025 will also see the
development of our strategy to 2030.

50 Financial review and statements

Key risk Nature of risk Management of risk
Quality Our work lacks
sufficient 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 2024 we designed quality frameworks with clear
responsibilities for both internal and externally
commissioned work, which will be embedded
during2025.
People risk Failure to attract,
develop and retain
the people we need to
deliver the Foundation’s
strategy.		 The Remuneration and Governance Committee
determines the framework for the overall reward
strategy applicable to all Foundation staff.
In 2024, our EDI strategy was developed with oversight
from the CEO and approved by the board. Delivery
of the strategy is supported by an action plan and
delivery group. Delivery of other aspects of the People
Plan continued, though due to the long term nature of
some initiatives, impact will take time to measure. The
timing and delivery of the People Plan will, necessarily,
continue to take into account other changes across the
organistion (see change management risk below).
Change
management		 The Future Foundation
change programme fails
to deliver the planned
benefits, resulting in
failure to materialise
opportunities to align to
its strategy and improve
operational efficiency.		 In 2024, process improvement work was coordinated
by the Head of Organisational Change. The extent and
nature of wider change that the Foundation requires
was articulated with initial scoping.
In 2025, a Change Programme Director has been
appointed and, together with a bolstered team, will
oversee the initial stages of programme delivery.
Stability of the overall change agenda, as well as
monitoring for change fatigue, will be important for
successful delivery.

An important part of risk management is our internal audit strategy. Through this ensures all risks on our corporate risk register are covered in a 3–4-year cycle. For the first time we have received a ‘moderate’ internal audit annual report opinion, the second highest rating. This reflects that, whilst there is further work to be done, in the main we are now operating in an environment where there are appropriate procedures and controls in place to mitigate the key risks, accepting that there are ongoing opportunities to improve their efficiency and effectiveness.

This aligns with the conclusions of recent work on our assurance map, which provides an overview of the key assurance mechanisms in place across the Foundation. The conclusion of the second full review of the map was that ‘the Foundation has made significant improvements to its assurance structures in comparison to those observed during the last assurance mapping exercise in 2022.’

Financial review and statements 51

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		 Programme related
investments
committee (from
November 2023)		 Remuneration
and
Governance
Committee
Hugh Taylor Chair (until end
July 2025)
David Behan (appointed
July 2025)
Katie Blacklock Chair (from
October 2024)
Dawn Edge
Eric Gregory (until end
June 2025)		 Chair Chair
Loraine Hawkins
Ruth Hussey Vice Chair Chair
Ravi Gurumurthy
Branwen
Jeffreys		 (until July
2024)
Paul Najsarek
Roland Sinker
David Smart* Chair (until
October 2024)
Rosalind Smyth (until July
2025)
Rachel Sylvester (appointed
June 2024)

*David Smart has been engaged by the Foundation as a paid Investment Consultant since 31 October 2024. Arrangements are in line with the Foundation’s Policy on Payments to Governors Providing Contracted Services (last reviewed by the board in July 2024) and follows the Charity Commission’s guidance on payments for trustees.

52 Financial review and statements

The following served as independent members of committees during 2024.

Name Audit Committee Investment Committee
Ingeborg Dybdal Øie (until February 2024)
Robert Beveridge (stepped down June 2025)
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 and the board reviews its governor training and development policy every 2 years. The articles of association set a minimum number of trustees at 5 and a maximum at 15.

Organisational structure and how decisions

are made

The board of governors has set down a schedule of matters which it cannot delegate in line with the Charity Commission guidance on matters reserved for board decision. These include:

In addition, the following are established as committees of the board of the Foundation in accordance with the articles of association. Each operates in

Financial review and statements 53

accordance with terms of reference, which ensures the committee is properly constituted with an appropriate membership of governors and experienced independent members as needed and a clear set of responsibilities and authorities.

The Foundation has three subsidiary companies:

54 Financial review and statements

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.

Chief Executive Jennifer Dixon
Chief Operating Officer Nick Bateson*
Chief Investment Officer Aidan Kearney (until May 2024)
Jenny Rodgers (April to September 2024)
Director of Communications Patrick South
Director of Health Jo Bibby
Director of Innovation and Improvement Malte Gerhold
Director of Policy Hugh Alderwick
Director of Research and the REAL Centre Anita Charlesworth (until September 2024)
Director of Data Analytics (until August 2024)
Director of Research and Analysis
(from September 2024)		 Charles Tallack

*The Chief Investment Officer role has been covered by Nick Bateson with David Smart stepping down as Chair of Investment committee and acting as a consultant.

Financial review and statements 55

The charity’s registered office and list of key advisers can be found in legal and administrative information (page 33).

Principal activities and development

The Health Foundation is an independent charitable organisation working to build a healthier 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:

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

56 Financial review and statements

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 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:

Financial review and statements 57

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 senior 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 Trustees’ report, including Strategic report, prepared under the Charities Act 2011 and the Companies Act 2006, was approved by the governors on 17 July 2025 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:

Sir Hugh Taylor, Chair 17 July 2025

58 Financial review and statements

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 2024, 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 statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards including FRS 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland (United Kingdom Generally Accepted Accounting Practice).

In our opinion the financial statements:

Basis for opinion

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

Financial review and statements 59

to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Conclusions relating to going concern

In auditing the financial statements, we have concluded that the trustees’ use of the going concern basis of accounting in the preparation of the financial 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 12 months from when the financial statements are authorised for issue.

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

Other information

The other information comprises the information included in the annual report 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.

60 Financial review and statements

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 pp 56–57, 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

Financial review and statements 61

such internal control as the trustees determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.

In preparing the financial statements, the trustees are responsible for assessing the 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, the Charities Act 2011, FRS 102 and the Charities SORP 2019. We evaluated management’s incentives and opportunities for fraudulent

62 Financial review and statements

manipulation of the financial statements (including the risk of override of controls), and determined that the principal risks were related posting manual journal entries to manipulate financial results, management bias through judgements and assumptions in significant accounting estimates, in particular in relation to investment valuations and the grants payable.

Our audit procedures were designed to respond to those identified risks, including non-compliance with laws and regulations (irregularities) and fraud that are material to the financial statements. Our audit procedures included but were not limited to:

Our audit procedures in relation to fraud included but were not limited to:

Financial review and statements 63

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 (Senior Statutory Auditor)

For and on behalf of UHY Hacker Young

Chartered Accountants and Statutory Auditor

4 Thomas More Square London E1W 1YW

23 July 2025

64 Financial review and statements

Financial statements

Consolidated statement of financial activities for the year ended 31 December 2024

Notes Notes Unrestricted
fund
£’000		 Restricted
fund
£’000		 Non
Controlling
Interest
(NCI) fund
£’000		 Expendable
Endowment
fund
£’000		 Total
2024
£’000		 Total
2023
£’000
Income:
Charitable
activities		 3 615 1,724 – – 2,339 2,017
Investment
income		 4 14,864 – – – 14,864 16,538
Capital applied
to income		 5 33,016 – – (33,016) – –
Total income 48,495 1,724 – (33,016) 17,203 18,555
Expenditure:
Fund
management		 6 – – – 16,857 16,857 14,905
Charitable
activities		 7 48,495 1,932 – – 50,427 47,812
Total resources
expended		 48,495 1,932 – 16,857 67,284 62,717
Operating
(deficit)/surplus		 – (208) – (49,873) (50,081) (44,162)
Net gain/(loss)
on investments		 11 103,821 103,821 71,640
Net
(expenditure)/
income for the
year before NCI		 – (208) – 53,948 53,740 27,478
NCI income/
(expenditure)
for the year		 – – (551) – (551) 113
Net income/
(expenditure)
for the year		 – (208) (551) 53,948 53,189 27,591
Fund balances
as at 1 January		 – 658 113 1,174,300 1,175,071 1,147,480
Fund
balances as at
31 December		 – 450 (438) 1,228,248 1,228,260 1,175,071

The statement of financial activities includes all gains and losses recognised in the year. All income and expenditure is derived from continuing activities. For the full comparatives see note 28.

Financial review and statements 65

Consolidated balance sheet as at 31 December 2024

Notes Notes 2024
£’000
£’000		 2024
£’000
£’000		 2023
£’000
£’000		 2023
£’000
£’000
Fixed assets:
Intangible fixed assets 12 539 1,111
Tangible fixed assets 13 2,256 2,740
Investments 14 1,242,010 1,196,475
Programme-related investment 14 526 526
Total fixed assets 1,245,331 1,200,852
Current assets:
Debtors 16 1,355 1,476
Cash and short-term deposits 5,033 7,422
Total current assets 6,388 8,898
Current liabilities:
Amounts falling due within one year 17 (13,695) (18,816)
Net current liabilities (7,307) (9,918)
Total assets less current liabilities 1,238,024 1,190,934
Creditors: amounts falling due after
more than one year		 18 (9,066) (15,234)
Provisions for liabilities 20 (698) (629)
Net assets 1,228,260 1,175,071
Capital funds
Endowment funds general 1,228,248 1,174,299
Income funds
Unrestricted fund – –
Restricted funds 450 658
Total funds before NCI 1,228,698 1,174,957
Non Controlling Interest (NCI)
funds
NCI fund (438) 114
Total funds 1,228,260 1,175,071

The accounts were approved by the governors, and authorised for issue on 17 July 2025 and signed by:

Sir Hugh Taylor

Trustee

Katie Blacklock

Trustee

Company Registration No. 01714937

66 Financial review and statements

Charity balance sheet as at 31 December 2024

Notes Notes 2024
£’000
£’000		 2024
£’000
£’000		 2023
£’000
£’000		 2023
£’000
£’000
Fixed assets:
Intangible fixed assets 12 134 659
Tangible fixed assets 13 2,235 2,713
Investments 14 847,295 760,352
Programme-related investment 14 396,663 439,917
Total fixed assets 1,246,327 1,203,641
Current assets:
Debtors 16 1,109 1,239
Cash and short-term deposits 4,035 4,632
Total current assets 5,144 5,871
Current liabilities:
Amounts falling due within one year 17 (13,618) (18,709)
Net current liabilities (8,474) (12,838)
Total assets less current liabilities 1,237,853 1,190,803
Creditors: amounts falling due after
more than one year		 18 (9,066) (15,234)
Provisions for liabilities 20 (698) (629)
Net assets 1,228,089 1,174,940
Capital funds
Endowment funds general 1,227,639 1,174,282
Income funds
Unrestricted fund – –
Restricted funds 450 658
Total funds 1,228,089 1,174,940

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 company’s net income for the year is £53,149k (2023: net income £27,701k).

The accounts were approved by the governors, and authorised for issue on 17 July 2025 and signed by:

Sir Hugh Taylor Trustee

Katie Blacklock

Trustee

Company Registration No. 01714937

Financial review and statements 67

Consolidated statement of cash flows for the year

ended 31 December 2024

Notes Notes 2024
£’000
£’000		 2024
£’000
£’000		 2023
£’000
£’000		 2023
£’000
£’000
Cash flows from operating
activities:
Cash absorbed by operations 27 (58,524) (51,586)
Investment activities:
Cost of developing intangible
assets		 – (475)
Purchase of tangible fixed assets (161) (160)
Investment proceeds re-invested (14,246) (15,848)
Withdrawals from investments 72,535 68,030
Investment management fees (16,857) (14,905)
Investment income 14,864 16,538
Net cash generated from investing
activities		 56,135 53,180
Net (decrease)/increase in cash and
cash equivalents		 (2,389) 1,594
Cash and cash equivalents at
beginningof year		 7,422 5,828
Cash and cash equivalents at end
of year		 5,033 7,422

68 Financial review and statements

Notes to the financial

statements for the year ended 31 December 2024

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, Medtrust Innovations Limited and THIS Labs Ltd.

Financial review and statements 69

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 company’s net income for the year is £53,149k (2023: net income £27,701k).

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 political and economic challenges facing global markets. There is market uncertainty which may lead to some volatility. 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 2024 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.

70 Financial review and statements

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:

Financial review and statements 71

which the contributions are paid. Provision is made for the discounted expected future costs of unfunded pension benefit commitments at each balance sheet date, based on actuarial advice.

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. 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.

72 Financial review and statements

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 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.

Financial review and statements 73

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.

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.

74 Financial review and statements

Derecognition of financial liabilities

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

1.13 Provisions and grants

Provisions and grants 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.

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 or grant is measured at present value the unwinding of the discount is recognised as a finance cost or grant expense 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.

Financial review and statements 75

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.

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 company’s net income for the year is £53,149k (2023: net income £27,701k).

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 which 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

76 Financial review and statements

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.

3.0 Charitable activities

3.0
Charitable activit		 ies
Share of profit
in_BMJ Quality_
& Safety
£’000		 THIS Labs Ltd
£’000		 Other income
£’000		 Total
2024
£’000		 Total
2023
£’000
Other income* 280 175 1,884 2,339 2,017
Analysis by funds:
Unrestricted funds 280 175 160 615
Restricted funds – – 1,724 1,724
280 175 1,884 2,339
For year ended 31 December
2023:
Unrestricted funds 419 46 – 465
Restricted funds – – 1,552 1,552
419 46 1,552 2,017

*In 2024, we received restricted income of £1,724k (2023: £1,297k) mainly from NHS England for Q, a jointly funded initiative.

4.0 Investments

4.0
Investments
2024
£’000		 2023
£’000
Income from listed investments 9,521 8,338
Fixed interest income 2,009 2,285
Property fund income 3,463 5,915
Alternatives income (129) –
14,864 16,538

The reduction in alternatives income was a result of a slowed exit environment after a period of high interest rates.

Financial review and statements 77

5.0 Capital applied to income

Unrestricted
funds
£’000		 Endowment
funds
general
£’000		 Total
2024
£’000		 Total
2023
£’000
Released from endowment
funds		 33,016 (33,016) – –
For the year ended
31 December 2023		 29,242 (29,242) – –

6.0 Fund management

6.0
Fund management
2024
£’000		 2023
£’000
Cost of fund management:
Investment advisory costs 344 316
Staff and operating costs 666 441
Custodian fees 78 85
Investment managers’ fees 15,769 14,063
16,857 14,905

The investment managers’ fees of £15,769k (2023: £14,063k) includes: management fees of £9,464k (2023: £9,459k), incurred on the endowment value of £1,242,010k (2023: £1,196,475k) and performance fees of £5,261k (2023: £3,539k), the increase is driven by a large performance fee relating to a private equity distribution in 2024.

The cost of raising funds is 1.3% (2023: 1.2%).

78 Financial review and statements

7.0 Expenditure on charitable activities

Effective
innovation and
improvement
in health and
care
£’000		 Better health
and care
policy making
£’000		 Improving
health and
reducing
inequalities
£’000		 Cross-cutting
strategic
activities
£’000		 Total
2024
£’000		 Total
2023
£’000
Grant
funding of
activities
(see note 29)		 8,470 1,765 4,782 1,480 16,497 16,847
Direct costs* 11,516 2,087 5,655 1,995 21,253 19,068
Share of
support
costs*		 6,138 1,279 3,465 1,073 11,955 11,476
Share of
governance
costs*		 371 77 209 65 722 421
26,495 5,208 14,111 4,613 50,427 47,812
*See note 8
Analysis by
fund:
Unrestricted
funds		 24,563 5,208 14,111 4,613 48,495 46,245
Restricted
funds		 1,932 – – – 1,932 1,567
26,495 5,208 14,111 4,613 50,427 47,812

2024 was the middle year of our 3 year strategy and the above table reflects the three strategic priorities for 2023–5.

For the year ended 31 December 2023

Unrestricted
funds
Restricted
funds		 Effective
innovation and
improvement
in health
and care
£’000



Better health
and care
policy making
£’000


Improving
health and
reducing
inequalities
£’000


Cross-cutting
strategic
activities
£’000


Total
£’000
14,930 10,895 16,595 3,825 46,245
1,567 –
–		 – 1,567
16,497 10,895 16,595 3,825 47,812

Financial review and statements 79

8.0 Direct, support and governance costs

Direct costs
£’000		 Support costs
£’000		 Governance
costs
£’000		 2024
£’000		 2023
£’000
Staff costs 15,843 3,929 460 20,232 17,607
Depreciation – 1,163 – 1,163 1,268
Property costs – 1,794 – 1,794 1,705
Technology
costs		 211 1,962 – 2,173 2,677
Other direct/
support costs		 5,199 2,965 – 8,164 7,394
Audit fees – – 71 71 54
Legal and
professional		 – 142 54 196 190
Internal audit – – 93 93 53
Other
governance
costs		 – – 44 44 17
21,253 11,955 722 33,930 30,965

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 £71k (2023: £54k) for audit fees and £8k (2023: £7k) for non-audit services.

9.0 Governors

David Smart has acted as an investment consultant to the Investment team from October 2024, temporarily stepping down from his role as Investment Committee Chair. Interim Investment Committee Chair is Katie Blacklock. David was recompensed £60k in 2024.

None of other the governors (or any persons connected with them) received any remuneration or benefits from the Foundation during the year.

Trustees’ expenses received totalled £63k (2023: £2k), including the investment consultant fees paid to David Smart.

80 Financial review and statements

10.0 Employment costs

10.0
Employment costs
2024
£’000		 2023
£’000
Wages and salaries 17,123 14,854
Social security costs 1,938 1,692
Other pension costs 1,617 1,358
Other costs 9 88
Total employment costs* 20,687 17,992

*Total employment costs during the year were £20,687k (2023: £17,992k). This includes salary costs relating to management of the endowment of £455k (2023: £384k).

The average number of employees during the year was 273 (2023: 246), which equated to a full time equivalent of 254 (2023: 231).

In 2024 we invested in our staff team to deliver and support our work increasing staffing numbers and costs.

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

more were:
2024 2023
£60,001–£70,000 46 34
£70,001–£80,000 29 21
£80,001–£90,000 16 19
£90,001–£100,000 10 9
£100,001–£110,000 8 6
£110,001–£120,000 7 3
£120,001–£130,000 4 2
£130,001–£140,000 1 –
£140,001–£150,000 1 2
£150,001–£160,000 1 1
£160,001–£170,000 1 1
£180,001–£190,000 1 1
£170,001–£180,000 1 1
£190,001–£200,000 – 1
£200,001–£210,000 1 1
£210,001–£220,000 1 –
£270,001–£280,000 – 1
£280,001–£290,000 1 –

The calculation for annual remuneration includes salary, NI and Employers Pension contribution.

Financial review and statements 81

11.0 Net gain/(loss) on investments

11.0
Net gain/(loss) on investments
2024
£’000		 2023
£’000
Revaluation of investments 103,821 71,640

Net revaluation of investments comprises:

12.0 Intangible fixed assets

Group Software
£’000		 Q Project
£’000		 Total
£’000
Cost:
At 1 January 2024 2,895 2,186 5,081
Write offs (1,298) – (1,298)
At 31 December 2024 1,597 2,186 3,783
Amortisation and impairment:
At 1 January 2024 1,785 2,186 3,971
Amortisation charge in the year 225 – 225
Write offs (952) – (952)
At 31 December 2024 1,058 2,186 3,244
Carrying amount:
At 31 December 2024 539 – 539
At 31 December 2023 1,111 – 1,111

Software relates to (i) our key office applications, including finance and grant management systems, and Microsoft Office 365 applications; (ii) our secure data environment.

The write offs were for an old grant system that is no longer used by the Foundation (£523k) which was fully depreciated and to write off the data analytics platform that is being replaced (£775k) which included a write down of £346k as it was not yet fully depreciated.

82 Financial review and statements

12.0 Intangible fixed assets (continued)

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 5 years and is still in use.

Charity Software
£’000		 Q Project
£’000		 Total
£’000
Cost:
At 1 January 2024 2,421 2,186 4,607
Write offs (1,298) – (1,298)
At 31 December 2024 1,123 2,186 3,309
Amortisation and impairment:
At 1 January 2024 1,762 2,186 3,948
Amortisation charge in the year 179 – 179
Write offs (952) – (952)
At 31 December 2024 989 2,186 3,175
Carrying amount:
At 31 December 2024 134 – 134
At 31 December 2023 659 – 659

Financial review and statements 83

13.0 Tangible fixed assets

----- Start of picture text -----
Group Fixtures and Computer Total
fittings equipment
£’000 £’000 £’000
Cost:
At 1 January 2024 5,382 1,031 6,413
Additions 23 138 161
Write offs – (360) (360)
At 31 December 2024 5,405 809 6,214
Depreciation and impairment:
At 1 January 2024 2,755 918 3,673
Depreciation charge in the year 555 90 645
Write offs – (360) (360)
At 31 December 2024 3,310 648 3,958
Carrying amount:
At 31 December 2024 2,095 161 2,256
At 31 December 2023 2,627 113 2,740
Charity Fixtures and Computer Total
fittings equipment
£’000 £’000 £’000
Cost:
At 1 January 2024 5,382 999 6,381
Additions 23 138 161
Write offs – (360) (360)
At 31 December 2024 5,405 777 6,182
Depreciation and impairment:
At 1 January 2024 2,755 913 3,668
Depreciation charge in the year 555 84 639
Write offs – (360) (360)
At 31 December 2024 3,310 637 3,947
Carrying amount:
At 31 December 2024 2,095 140 2,235
At 31 December 2023 2,627 86 2,713
----- End of picture text -----

84 Financial review and statements

14.0 Fixed assets investments

14.0 Fixed assets investments 14.0 Fixed assets investments 14.0 Fixed assets investments
Investments
Group Portfolio
£’000		 Other
£’000		 Total
£’000
Valuation:
At 1 January 2024 1,196,475 526 1,197,001
Valuation changes 103,821 – 103,821
Income (excluding bank interest) 14,212 – 14,212
Investment management costs included in
the fund		 (14,379) – (14,379)
Net withdrawals from portfolio (58,119) – (58,119)
At 31 December 2024 1,242,010 526 1,242,536
Cost:
At 31 December 2024 1,139,632 526 1,140,158
At 31 December 2023 1,031,967 526 1,032,493
Notes 2024
£’000		 2023
£’000
Other investments comprise:
Programme-related investments 26 526 526
Investments at fair value comprise:
Property and infrastructure funds 130,466 145,980
Equities 661,774 621,159
Fixed interest 92,675 38,284
Alternatives 312,450 311,249
Impact 2,599 –
Cash 42,046 79,803
1,242,010 1,196,475

Financial review and statements 85

14.0 Fixed assets investments (continued)

Investments Investments Investments
Charity Portfolio
£’000		 Other
£’000		 Total
£’000
Valuation:
At 1 January 2024 760,352 439,917 1,200,269
Valuation changes 73,808 28,167 101,975
Income 10,448 3,764 14,212
Investment management costs included in
the fund		 (2,444) (11,935) (14,379)
Net investments/(withdrawals) from portfolio 5,131 (63,250) (58,119)
At 31 December 2024 847,295 396,663 1,243,958
Cost:
At 31 December 2024 839,893 300,265 1,140,158
At 31 December 2023 695,393 337,100 1,032,493
Notes 2024
£’000		 2023
£’000
Other investments comprise:
Investment in subsidiaries 396,136 439,391
Programme-related investments 526 526
Investment in subsidiaries 26 396,662 439,917
Investments at fair value comprise:
Property funds 63,876 79,120
Equities 661,774 621,159
Fixed interest 92,675 38,284
Alternatives 2,161 821
Cash 26,809 20,968
847,295 760,352

A currency hedging programme was in place during the year to manage foreign currency exchange risk. At 31 December 2024, 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.

86 Financial review and statements

14.0 Fixed assets investments (continued)

At 31 December 2024, the Victoria Fund held contracts to buy £225,604k and $41,024k at fixed rates (2023: £257,945k and $69,149k). The unrealised loss associated with these forward currency contracts totalled £4,051k as at 31 December 2024 (2023: £1,471k gain).

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 as at 31 December 2024:

Less than
6 months
£’000		 6–12
months
£’000		 More than
12 months
£’000		 Long-term
lock up*
£’000
Total non-current assets – – – 300,980
Total current assets 98,426 – –
Total current liabilities (4,515) – –

*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 £139,274k (2023: £137,444k) for private equity and infrastructure from total commitments of £451,509k (2023: £422,977k). These commitments form part of the planned asset allocation and will be met from within the existing endowment investments.

In 2024 for the first time the charity invested directly in alternative assets outside of the Victoria Fund for the impact investment allocation. In September 2024 £4m was committed to Meridian Health Ventures Fund I Limited Partnership with an initial capital call of £2.5m. This venture fund invests in UK companies across digital health, med-tech and enterprise software primarily in the UK, seeking to improve patient outcomes as well as the lives of healthcare workers in the UK and beyond. In December 2024 $10m was committed JP Morgan Campbell global forestry and climate solutions fund II.

Financial review and statements 87

15.0 Financial instruments

15.0
Financial instruments
Group 2024
£’000		 2023
£’000
Carrying amount of financial assets:
Debt instruments measured at amortised cost 5,297 7,851
Instruments measured at fair value through profit or loss 1,242,010 1,196,475
Carrying amount of financial liabilities:
Measured at amortised cost 22,761 34,051
Charity 2024
£’000		 2023
£’000
Carrying amount of financial assets:
Debt instruments measured at amortised cost 4,053 4,824
Instruments measured at fair value through profit or loss 847,295 760,352
Carrying amount of financial liabilities:
Measured at amortised cost 27,717 41,365

16.0 Debtors: Amounts falling due within 1 year

Group Group Charity Charity
2024
£’000		 2023
£’000		 2024
£’000		 2023
£’000
Other debtors 264 429 4 177
Prepayments and accrued
income		 1,091 1,047 1,091 1,047
Amounts due from subsidiaries – – 14 15
1,355 1,476 1,109 1,239

88 Financial review and statements

17.0 Creditors: Amounts falling due within 1 year

Group Group Charity Charity
2024
£’000		 2023
£’000		 2024
£’000		 2023
£’000
Trade creditors 617 942 540 834
Grants payable 9,806 13,856 9,806 13,856
Other creditors 1,419 1,861 1,419 1,863
Accruals and deferred income 1,853 2,157 1,853 2,156
13,695 18,816 13,618 18,709

18.0 Creditors: Amounts falling due after more than 1 year

Group Group Charity Charity
2024
£’000		 2023
£’000		 2024
£’000		 2023
£’000
Grants payable – in 2 to 5 years 9,066 15,234 9,066 15,234

19.0 Grants payable

19.0 Grants payable
2024
£’000		 2023
£’000
As at 1 January 29,090 36,588
Grants committed in the year 16,127 17,081
Paid during the year (26,809) (23,446)
Discounting applied to grants payable in more than a year 464 (1,133)
As at 31 December 18,872 29,090
Split into:
Grants payable – due within 1 year (note 17) 9,806 13,856
Grants payable – in 2 to 5 years (note 18) 9,066 15,234
As at 31 December 18,872 29,090

Financial review and statements 89

20.0 Provisions for liabilities

20.0 Provisions for liabilities 20.0 Provisions for liabilities
2024
£’000		 2023
£’000
Pension obligations 411 438
Dilapidations 287 191
698 629
Movement on provisions:
Pension
obligations
£’000		 Dilapidations
£’000		 Total
£’000
At 1 January 2024 438 191 629
Increase/(decrease) in the year – 96 96
Payment in the year (27) – (27)
At 31 December 2024 411 287 698

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 £1,590k (2023: £1,332k). There was £6k in outstanding contributions at 31 December 2024 (2023: £202k).

b) Other retirement benefits

The Foundation has an unfunded future commitment to a former employee. The contractual commitment (as defined in the 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 2024, based on advice from an actuary, is estimated to be £411k (2023: £438k). This provision will be reviewed in 2026.

90 Financial review and statements

22.0 Analysis of net assets between funds

Group Unrestricted
fund
£’000		 Restricted
fund
£’000		 Non
Controlling
Interest
fund
£’000		 Expendable
Endowment
fund
£’000		 Total
£’000
Fund balances at 31 December 2024 are represented by:
Intangible
fixed assets		 539 – – – 539
Tangible
assets		 2,256 – – – 2,256
Programme
related		 526 – – – 526
Investments 13,819 – – 1,228,191 1,242,010
Current
(liabilities)/
assets		 (7,376) 450 (438) 57 (7,307)
Long term
liabilities		 (9,066) – – – (9,066)
Provisions (698) – – – (698)
– 450 (438) 1,228,248 1,228,260
Charity Unrestricted
fund
£’000		 Restricted
fund
£’000		 Non
Controlling
Interest
fund
£’000		 Expendable
Endowment
fund
£’000		 Total
£’000
Fund balances at 31 December 2024 are represented by:
Intangible
fixed assets		 134 – – – 134
Tangible
assets		 2,235 – – – 2,235
Investments 16,376 – – 830,919 847,295
Investment in
subsidiary		 – – – 396,663 396,663
Current
(liabilities)/
assets		 (8,981) 450 – 57 (8,474)
Long term
liabilities		 (9,066) – – – (9,066)
Provisions (698) – – – (698)
– 450 – 1,227,639 1,228,089

23.0 Capital commitments

The Foundation has a number of contracts that have been entered into, but which are not disclosed 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 £12,715k at 31 December 2024 (2023: £16,225k).

Financial review and statements 91

24.0 Financial commitments

At 31 December 2024, 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
2024
£’000		 2023
£’000		 2024
£’000		 2023
£’000
Expiry date:
Within 1 year 1,650 1,655 23 23
Between 2 and 5 years 4,539 6,189 – 23
Over 5 years – – – –

25.0 Related party transactions

David Smart has been engaged by the Foundation as a paid Investment Consultant since 31 October 2024. Arrangements are in line with the Foundation’s Policy on Payments to Governors Providing Contracted Services (last reviewed by the board in July 2024) and follows the Charity Commission’s guidance on payments for trustees.

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 2024 are noted in the table below.

92 Financial review and statements

25.0 Related party transactions (continued)

Board member/
senior management		 Role in associated organisation Associated organisation
Paul Najsarek Board member (until September
2024)		 What Works Centre for Wellbeing
Hugh Taylor Trustee Cicely Saunders International
Loraine Hawkins Board member Centre for Health Economics and
Policy Innovation, Imperial College
Rosalind Smyth Trustee Academy of Medical Sciences
University of Nottingham
University of Cambridge
Ruth Hussey Trustee NHS Cheshire and Merseyside ICB
Public Health Wales NHS Trust
Mark Chaloner Investment Committee member British Red Cross

During the year, Victoria Fund LP Incorporated, a subsidiary of the Foundation, received no investment contributions from the charity (2023, £0). Medtrust Innovations Limited, a subsidiary of the Foundation, donated its profit of £168k (2023: £130k) to the Foundation. In 2024 THF entered into a working relationship with THIS Labs outside of the investment made in 2023, the contract value of which was £18k, and was completed in the year.

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 governors’ annual report. Total remuneration of this group in the year, was as follows:

2024
£’000		 2023
£’000
Key management personnel 1,652 1,564

Financial review and statements 93

26.0 Subsidiaries

The Foundation had three subsidiary undertakings and the details at 31 December 2024 are as follows:

Name of undertaking Registered office 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		 – –
THISLabs Limited England and
Wales		 Business and
domestic
software
development		 Ordinary A 70.17

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 with the same registered office as the Foundation: 8 Salisbury Square, London, EC4Y 8AP.

In March 2011, the Foundation purchased 524,998 ordinary shares of Medtrust at £1 each to finance an investment 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 2024, Medtrust had fixed assets of £526k (2023: £526k) and net current assets of £168k (2023: £145k). The shareholders’ funds include called-up share capital of £526k (2023: £526k) and reserves of £168k (2023: £130k).

During the year, Medtrust had an operating profit of £168k (2023: £130k). The sum equivalent to its taxable profits will be donated to the Foundation, as provided for in Medtrust’s Articles of Association.

94 Financial review and statements

26.0 Subsidiaries (continued)

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. It is a vehicle to invest in a combination of hedge funds, private equity and private infrastructure, with a registered office of Oak House, Hirzel Street, St. Peter Port, Guernsey, GY1 2NP. 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.

The Health Foundation as the limited partner 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 2024, the Victoria Fund had net investment assets of £388,411k (2023: £433,464k) and the value of its net assets was £394,891k (2023: £436,631k). Net profit in the year was £22,537k (2023: £6,823k).

THIS Labs Ltd (THIS Labs)

THIS Labs is a private limited company and a 70.12% owned subsidiary of the Health Foundation, incorporated in November 2022 and began trading in May 2023. THIS Labs was created to drive innovation and improved approaches to engagement in research and consultation projects. The registered office is Burnham House, Splash Lane, Wyton, PE28 2AF.

At 31 December 2024, THIS Labs had fixed assets of £423k (2023: £477k) and net current assets of £997k (2023: £2,782k). The shareholders’ funds include called-up share capital of £1k (2023: £1k) and reserves of £1,420k (2023: £3,259k).

In 2024 THIS Labs had an operating loss of £1,839k (2023: loss of £1,221k).

Financial review and statements 95

26.0 Subsidiaries (continued)

The original investment in THIS Labs by the non-controlling interest had a asset value of £0.5m for 29.83% of the company. This included the intellectual property associated with the proprietary software. Due to the accumulated losses to date, the non-controlling interest’s share of those losses is a deficit of £438k (2023: £113k asset), which has been shown within equity in the Foundation accounts. The non-controlling interest deficit is not a cause for concern as it was expected as part of the start up phase of that company. In April 2025 the Foundation invested a further £1.5m as a Convertible Loan Note into THIS Labs and no further investment is anticipated.

27.0 Cash used by operations – Group

27.0 Cash used by operations – Group
2024
£’000		 2023
£’000
Surplus for the year 53,189 27,591
Adjustments for:
Investment income recognised in profit or loss (14,864) (16,538)
Cost of raising funds 16,857 14,905
Fair value (gains) and losses on investments (103,821) (71,640)
Depreciation, amortisation and impairment of fixed assets 1,214 1,295
Movements in working capital:
Decrease/(increase) in debtors 121 (119)
Decrease in creditors (11,289) (7,156)
Increase in provisions 69 75
Cash absorbed by operations (58,524) (51,587)

96 Financial review and statements

28.0 Comparative consolidated statement of financial activities for the year ended 31 December 2023

Notes Notes Unrestricted
fund
£’000		 Restricted
fund
£’000		 Non
controlling
Interest
(NCI) fund
£’000		 Expendable
Endowment
fund
£’000		 Total
2023
£’000
Income:
Charitable activities 3 465 1,552 – – 2,017
Investments 4 16,538 – – – 16,538
Capital applied to
income		 5 29,242 – – (29,242) –
Total income 46,245 1,552 – (29,242) 18,555
Expenditure:
Fund management 6 – – – 14,905 14,905
Charitable activities 7 46,245 1,567 – – 47,812
Total resources
expended		 46,245 1,567 14,905 62,717
Operating profit/
(deficit)		 – (15) – (44,147) (44,162)
Net gain on
investments		 11 – – – 71,640 71,640
Net income/
(expenditure) for the
year before NCI		 – (15) – 27,493 27,478
NCI income/
(expenditure) for
the year		 – – 113 – 113
Net income/
(expenditure) for the
year		 – (15) 113 27,493 27,591
Fund balances as at
1 January 2023		 – 673 – 1,146,807 1,147,480
Fund balances as at
31 December 2023		 – 658 113 1,174,300 1,175,071

Financial review and statements 97

29.0 Grant funding

The Foundation funded £16,497k of grants in 2024 (2023: £16,847k). 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 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.

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

Lead recipient for strategic priority: Supporting radical innovation and improvement
in health and care services		 Total £
Sutton Primary Care Networks CiC 437,200
NHS Lanarkshire 435,900
University of Cambridge 366,300
NHS Bristol North Somerset and South Gloucestershire ICB 333,200
University of Birmingham 291,000
NHS Cambridgeshire and Peterborough ICB 194,500
NHS Elect 116,200
The improvement coalition CIC 100,000
The Centre for Sustainable Healthcare 88,000
Sheffield Health and Social Care NHS Foundation Trust 79,900
Solent NHS Trust 79,600
NHS Norfolk & Waveney Integrated Care Board 75,000
Aneurin Bevan University Health Board 62,500
SDSmyhealthcare 62,400
Stockport NHS Foundation Trust 62,300
University College Hospital (UCH) 62,000
Care City Innovation CIC 60,000
Rowcroft – Torbay & South Devon Hospice 57,800
Shared Lives Plus 57,500
Midlands and Lancashire Commissioning Support Unit 50,000
The Strategy Unit Midlands and Lancashire CSU 50,000
Your Healthcare CIC 49,800
Health Service Executive Ireland 40,000
Buckinghamshire Healthcare NHS Trust 40,000
Rotherham Doncaster and South Humber NHS Foundation Trust 40,000

98 Financial review and statements

29.0 Grant funding (continued)

29.0 Grant funding (continued)
Lead recipient for strategic priority: Supporting radical innovation and improvement
in health and care services (continued)		 Total £
Southern Health & Social Care Trust 40,000
NHS Gloucestershire ICB 40,000
University of the Highlands and Islands 40,000
Safety and Improvement in Healthcare CIC 39,900
Social Finance UK 39,900
Cardiff and Vale Regional Partnership Board/Cardiff and Vale University
Health Board		 39,900
Locala Health and Wellbeing 39,800
South Doc Services Ltd 39,500
Cwm Taf Morgannwg University Health Board 39,300
Staffordshire University 37,900
Arch Health CIC 35,000
Heart n Soul 30,000
University Hospitals Bristol and Weston NHS Foundation Trust 30,000
South Doc Services MyHealthcare Federation 27,000
NHS Dorset ICB 25,000
Health Innovation North East and North Cumbria 25,000
Health Innovation Manchester 24,900
NHS South West London ICB 24,800
Health Innovation Kent Surrey Sussex 23,600
Learningand Development Centre – Sentinel Limited 20,000
Improvement Academy 20,000
Royal Cornwall Hospitals NHS Trust 19,900
Yorkshire & Humber Improvement Academy 19,800
Health Innovation Network 19,700
University College London 10,700
King’s College London 9,900
Judy Walker Associates Ltd 6,600
Chelsea and Westminster Hospital NHS Foundation Trust (200)
Surrey and Borders Partnership NHS Trust (200)
Professional Record Standards Body (The PRSB) (400)
Institute for Healthcare Improvement (IHI) (400)
NHS Providers (500)
Nottinghamshire Healthcare NHS Foundation Trust (800)
Cornwall Partnership NHS Foundation Trust (1,200)
Powys County Council (2,700)
Association of Directors of Public Health (3,000)
Hexitime CIC (4,000)

Financial review and statements 99

29.0 Grant funding (continued)

29.0 Grant funding (continued)
Lead recipient for strategic priority: Supporting radical innovation and improvement
in health and care services (continued)		 Total £
University of Surrey (6,200)
The King’s Fund (7,400)
North East and North Cumbria Integrated Care System (11,500)
St George’s University Hospitals NHS Foundation Trust (14,900)
NHS England (34,000)
Manchester University NHS Foundation Trust (35,700)
Sheffield Teaching Hospitals NHS Foundation Trust (130,400)
Cambridge and Peterborough Foundation Trust (194,500)
Total 3,611,200
Lead recipient for strategic priority: Improving people’s health and
reducinginequalities		 Total £
Institute for Fiscal Studies (IFS) 174,600
Citizens Advice 163,500
Global Action Plan 139,800
Office for National Statistics 129,800
Forward Institute 100,000
Resolution Foundation 74,200
LivingWage Foundation 53,000
Crisis UK 43,000
Demos 40,100
Centre for Mental Health 40,100
What Works Centre for Wellbeing 30,000
IPPR 29,400
Fraser of Allander Institute University of Strathclyde 26,000
University Hospitals of Leicester NHS Trust 25,000
Glasgow City Council 25,000
Havant Borough Council 25,000
Food Foundation 21,600
Learningand Work Institute 13,800
University Hospitals Bristol and Weston NHS Foundation Trust 9,500
Imperial College London (13,700)
University of York (18,500)
Leeds City Council (44,000)
Total 1,087,200

100 Financial review and statements

29.0 Grant funding (continued)

29.0 Grant funding (continued)
Lead recipient for strategic priority: Providing evidence and analysis to improve
health and care policy		 Total £
The University of Manchester 67,600
Organisation for Economic Co-operation and Development (OECD) 50,700
Carers Trust 40,000
UKHACC 16,000
Brown University School of Public Health 3,700
University of Sheffield (4,600)
University College London (5,800)
Staffordshire University (38,000)
The Commonwealth Fund (68,000)
Total 61,600
Lead recipient for strategic priority: Cross cutting strategic activities Total £
Centre for Health Communication Research (CHCR) Enterprises Limited 96,000
Queen Mary University of London 73,600
Total 169,600
Services provided by third parties to support award holders and further the work of
the Foundation		 10,867,900
Grants and donations awarded to charities by governors 235,000
Movement in discounting of grants payable in more than a year 464,500
Total Grants 16,497,000

Financial review and statements 101

Appendix: Investment Fund Managers

Aikya Investment Management Pinnacle Investment Management Nova North, Suite 6.12 11 Bressenden Place London, SW1E 5BY United Kingdom

Axiom Investors 33 Benedict Place Greenwich, CT 06830 United States of America

BlackRock Investment Management Ltd 12 Throgmorton Avenue London, EC2N 2DL United Kingdom

Impax Asset Management Ireland Limited The Lennox Building Richmond Street South Dublin 2, D02 FK02 Ireland

Ninety One 25 Basinghall Street London, EC2V 5HA United Kingdom

Ownership Capital Herengracht 105-107 1015BE Amsterdam The Netherlands

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

Schroders Investment Management 1 London Wall Place London, EC2Y 5AU United Kingdom

Swiss Life 55 Wells Street London, W1T 3PT United Kingdom

Legal & General Investment Management One Coleman Street London, EC2R 5AA United Kingdom

TwentyFour Asset Management 8th Floor, The Monument Building 11 Monument Street London, EC3R 8AF United Kingdom

102 Financial review and statements

Antin Infrastructure Partners 374, rue Saint-Honoré 75001 Paris France Astignes Capital Asia Pte. Ltd One George Street #22-01 Singapore 049145 Singapore

Apollo Global Management 9 West 57th Street, 42nd Floor New York, NY 10019 United States of America

Bessemer Venture Partners 535 Middlefield Road Suite 245 Menlo Park, CA 94025 United States of America

Brookfield Infrastructure Brookfield Place, Suite 300 181 Bay Street Toronto, Ontario ON M5J 2T3 Canada

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

CBC Group Suite 4508, 45F, Tower 2, Plaza 66 1366 West Nanjing Road Shanghai 200040 China

Cortec Group 200 Park Avenue, 20th Floor New York, NY 10166 United States of America

Crescent Capital Partners Level 29, Governor Phillip Tower 1 Farrer Place Sydney NSW 2000 Australia

Cube Infrastructure Managers 41 Avenue de la Liberte Luxembourg, L-1931 Luxembourg

Deerfield Management Company 780 Third Avenue, 37th Floor New York, NY 10017 United States of America

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

Engine Ventures 501 Massachusetts Ave Cambridge, MA 02139 United States of America

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

Financial review and statements 103

General Atlantic 600 Steamboat Road Suite 105 Greenwich, CT 06830 United States of America

Glennmont Partners 25 Old Broad Street, Tower 42 Level 12A London, EC2N 1HQ United Kingdom

Harbourvest One Financial Center, 44th Floor Boston, MA 02111 United States of America

Investindustrial Partners 51 Avenue John Fitzgerald Kennedy Luxembourg L-1855 Luxembourg

I Squared Capital 410 Park Avenue, Suite 830 New York, NY 10022 United States of America

J.P. Morgan Campbell Global 10 South Dearborn Street, Suite 1400 Chicago, IL 60603 United States of America

Junto Offshore Management LP 450 Park Avenue, 25th Floor New York, NY 10022 United States of America

Meridian Health Ventures 75-79 York Road London, SE1 7NJ United Kingdom

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

Level Equity 140 East 45th Street, 39th Floor New York, NY 10017 United States of America

Lexington Capital Partners 399 Park Avenue, 20th Floor New York, NY 10022 United States of America

LGT Capital Partners 1133 Avenue of the Americas 30th Floor, New York, NY 10036 United States of America

LocalGlobe Unit 23 Tileyard Studios Tileyard Road London N7 9AH United Kingdom

Lone Star Funds 2711 North Haskell Avenue Suite 1700 Dallas, TX 75204 United States of America

104 Financial review and statements

Nordea Asset Management Holding AB Mäster Samuelsgatan 21 Stockholm, 105 71 Sweden

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

Omnes 37-41 rue du Rocher Paris 75008 France

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

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

Rubicon Technology Partners 200 Middlefield Road Suite 102 Menlo Park, CA 94025 United States of America

ROW Asset Management LLC 450 Newport Center Drive Suite 420 Newport Beach, CA 92660 United States of America

Scale Venture Partners 950 Tower Lane, Suite 700, Foster City, CA 94404 United States of America

Spring Lane Capital 50 Milk Street, 16th Floor Boston, MA 02109 United States of America

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

StepStone Group LP 505 5th Avenue 17th Floor New York, NY 10017 United States of America

Stonepeak Infrastructure Partners 55 Hudson Yards 550 W 34th Street, 48th Floor New York, NY 10001 United States of America

SV7 Impact Medicine Fund One Boston Place 201 Washington Street Suite 3900 Boston, MA 02108 United States of America

Sylebra Capital Management 28 Hennessy Road, 20th Floor Hong Kong

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Thoma Bravo 150 N. Riverside Plaza, Suite 2800 Chicago, IL 60606-1599 United States of America

True Ventures 530 Lytton Avenue Suite 303, Palo Alto, CA 94301 United States of America

Varadero Capital LP 452 Fifth Avenue, 30th Floor New York, NY 10018 United States of America

Verdane Capital Hieronymus Heyerdahlsgate 1 NO-0160 Oslo Norway

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

Vitruvian Partners 105 Wigmore Street London, W1U 1QY United Kingdom

Voloridge Investment Management 110 Front Street, Suite 400 Jupiter, FL 33477 United States of America

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The Health Foundation is an independent charitable organisation working to build a healthier UK.

Health is our most precious asset. Good health enables us to live happy, fulfilling lives, fuels our prosperity and helps build a stronger society. Yet good health remains out of reach for too many people in the UK and services are struggling to provide access to timely, high-quality care. It doesn’t have to be like this. Our mission is to help build a healthier UK by:

We’ll achieve this by producing research and analysis, shaping policy and practice, building skills, knowledge and capacity, and acting as a catalyst for change.

Everyone has a stake and a part to play in improving our health. By working together, we can build a healthier UK.

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The Health Foundation

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Registered charity number: 286967 Registered company number: 01714937 © 2025 The Health Foundation

108 Financial review and statements