Company registration number: 02487661 Charitable company registration number: 803533
## Limbless Association
(A company limited by guarantee)
Annual Report and Financial Statements
for the Year Ended 31 March 2024
Edmund Carr LLP Chartered Accountants 146 New London Road Chelmsford Essex CM2 0AW
## **Limbless Association**
## **Contents**
|Reference and Administrative Details|1|
|---|---|
|Trustees' Report|2 to 22|
|Independent Examiner's Report|23|
|Statement of Financial Activities|24|
|Balance Sheet|25|
|Notes to the Financial Statements|26 to 39|
## **Limbless Association**
## **Reference and Administrative Details**
|**Chairman**|Mr D M Rose|
|---|---|
|**Trustees**|Mr D M Rose|
||Mr M M Adam|
||Ms E R Dove|
||Mr P J Houghton|
||Mr P A Judkins|
||Mr A W Meyer|
|**Secretary**|Ms D J Bent|
|**Senior Management / Leadership**|Ms D J Bent, CEO|
|**Team**|Mr M Nsiah|
|**Registered Office**|Mayflower Community Hospital|
||Blunts Wall Road|
||Billericay|
||Essex|
||CM12 9SA|
||The charitable company is incorporated in England and Wales.|
|**Charitable company Registration**|803533|
|**Number**||
|**Company Registration Number**|02487661|
|**Independent Examiner**|Alex Stone FCCA|
||Edmund Carr LLP|
||Chartered Accountants|
||146 New London Road|
||Chelmsford|
||Essex|
||CM2 0AW|
Page 1
**Limbless Association**
## **Trustees’ Report**
## **OBJECTIVES AND ACTIVITIES**
## **Review of the financial year 1st April 2023 to 31[st] March 2024**
## **The Charity Background**
November 2023 saw the charity mark 40 years of supporting lives beyond limb loss. The Limbless Association (LA) is a registered charity that was originally established in 1983. Since then, it has grown to become a leading UK charity for people with limb loss. The LA was incorporated in 1990 and it was granted charitable status in Scotland in 2011 (Charity registration Nos. 803533 and SCO42256).
The Limbless Association began life as a campaigning organisation whereby it aimed to champion access to better levels of rehabilitation for civilian amputees. The charity was for several years based in south-west London, at Queen Mary’s Hospital, Roehampton (The Douglas Bader Rehabilitation Centre). This was the first-ever prosthetic centre in the UK (built in 1915) and is still regarded as a centre-of-excellence for prosthetic treatment and rehabilitation. Driven by the need of growing civilian amputee numbers, the charity’s focus developed into that of developing and providing support services.
The LA was formed by amputees and continues to this day to be a user led charity with the majority of its trustees, volunteers and several of its staff team having experienced limb loss. As we develop projects and services aimed at meeting the practical and emotional needs of amputees and their families we consult our community at every stage. This wealth of lived experiences helps inform and shape the charity’s aims and services.
## **We believe in a world where** _**No Amputee Need Cope Alone**_
Losing a limb at any age and for whatever reason is a frightening and isolating experience. While we recognise that clinical services have developed immeasurably during the lifetime of the charity, holistic support _**beyond the clinic room**_ remains inadequate. The hundreds of amputees we support each year are very well cared for in acute care and clinical rehabilitation settings. However, they struggle to navigate the challenges of living a new life with limb loss particularly in the first few weeks, months and years of amputation. Amputation is a very individual experience depending on a range of circumstances; cause, level, mental and physical health, social. The Limbless Association (LA) provides advice, information, support and connectivity to and for the limb-loss community. The LA aims to support people of all ages and backgrounds through a variety of programmes and services, offering an early intervention approach to individuals of any age, whether they are about to have an amputation, are already living with congenital limb impairment or have acquired limb-loss. Lack of information about and along the rehabilitation pathway is emphatically highlighted by our service users and members. We gather this evidence through members surveys and this was also supported in 2021 by the research prioritisation of the Amputation Special Interest Group (Vascular Society). In a recent LA survey, 90% of amputees (of less than two years) told us that they were struggling. We also offer assistance, support and information to carers, family members and friends. We exist to support all amputees and where appropriate will work closely with other UK charities, agencies and services to realise the best possible outcomes for each individual in order to educate and empower them to progress along the rehabilitation pathway.
We provide a national association of friends and contemporaries through the Limbless Association membership, currently free to all amputees and limb impaired persons of 18 years and over. Parents of younger amputees may join as a parent/guardian member. The Limbless Association is recognised across the sector and beyond as the leading UK civilian limb loss early intervention support charity. The LA continues to strengthen its national strategic involvement, aiming to support and champion a collective voice for the UK limb loss community across a range of topics and issues.
In November 2024, LA Chair of Trustees, David Rose met Rt. Hon. the Lord Mackinlay of Richborough and Wes Streeting Secretary of State for Health and Social Care at the House of Lords. Along with Tracy Ralph, LA Network Development Officer they had the opportunity of raising awareness of the multiple challenges those experiencing limb loss face. The charity welcomed the opportunity to share updates on its work and aims and were extremely grateful for their time.
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**Limbless Association**
## **Trustees’ Report**
These have been and continue to be extremely challenging times financially for individuals and organisations. As a small charity income from a variety of sources is vitally important for us to be able to continue and grow our work. Limbless Association continues to be supported by its members, friends, private donors, funders, Trusts and corporate sponsors. We are enormously grateful for their generosity and support without which we simply couldn’t do our work. We owe a debt of gratitude to all our supporters who enable the charity to continue to develop and offer its services to amputees at no cost. **Thus ensuring that no one is ever without the information and support they need at whatever stage of their limb loss and regardless of their ability to pay, whenever that support is needed. We believe in a world where** _**no amputee need cope alone.**_
**If you are able to support us to deliver this vital work then please consider making a donation or pledging - to give regularly. Call us: 01277 402331 or email enquires@limbless association.org**
## **Supporting Lives Beyond Limb Loss**
## **Our Aim**
To enable people in the United Kingdom of all ages who are without one or more limbs to achieve rehabilitation and independence in hospital, home, education, employment and the community.
## **Our Mission**
To support and empower all amputees to lead independent and fulfilled lives.
## **Our Vision**
A world where amputees of all ages are not disadvantaged by their disability and able to achieve rehabilitation and independence in hospital, home, education, employment and the community.
## **OUR GOALS**
- Offer excellent advice, information and support to amputees, their relatives, carers and friends at all stages of limb loss.
- Identify gaps in service provision and develop projects to meet the needs identified.
- Increase membership, volunteer and supporter numbers nationwide to maximise our collective voice.
- Listen to, engage with and influence our stakeholders.
- Increase organisational reach to those in need of LA services.
- Lead on strategic representation and influencing at local and national levels.
- Support medical research in areas of prevention, service improvement and prosthetics.
- Deliver an ambitious programme of activity to grow our income to ensure continuity and development of our services.
- To raise the profile of the charity as a major champion of the limb loss community
## **OUR VALUES**
## RESPECT
We treat people as individuals and how we would wish to be treated ourselves
## INTEGRITY
We do the right thing, not the easy thing – even if it takes more time and effort
## DIVERSITY
The LA embraces, encourages and celebrates diversity and strives to be inclusive in all aspects of its work
## ACHIEVEMENT
The LA will support its members, volunteers and staff to enable them to develop and thrive as individuals and as a team encouraging resilience and adaptability
## EXCELLENCE
We don’t settle for OK; we are determined to ensure quality in all our activities and aim to achieve more
## PROFESSIONALISM
Our services and projects will be developed and delivered with high levels of competence, efficiency and quality at their heart
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**Limbless Association**
## **Trustees’ Report**
## ASPIRING
The LA will be optimistic in its outlook and aspirational in all areas of the support it offers and looks to develop; practical and holistic interventions.
## TRUSTWORTHY
We will develop stakeholder relationships and endeavour to be considered a reliable, consistent and competent partner by the limb loss community and our funders.
## **A message from LA Chair of Trustees, David Rose**
## **Bridging the Gap**
What exactly is the 'gap' that needs to be bridged? We know that losing a limb can be an overwhelming and confusing experience. Therefore the Limbless Association offer a variety of services and projects for people living with limb loss to learn valuable tools to better navigate the challenges they may face as an amputee.
The life we live as an amputee is more often than not a physical and emotional challenge. I understand this reality based on over 45 years’ experience as an above-knee amputee. My life changed forever one September afternoon in 1979 and every day I've been adjusting to my different daily living reality. I can recount many occasions during these years where there has been a gap that has hindered my rehabilitation goals. My first prosthetic leg was a Hanger pylon - it was heavy, crudely constructed and hideously ugly. But it was all that was available through the NHS at that earlier time. But it was that or I would be using a wheelchair. There was the gap, and I had to bridge it as best I could.
One of the charity’s key interventions is the Volunteer Visitor programme – offering one to one peer support. We strongly believe, and can evidence through the programme, the power of peer support in bridging the practical and emotional gaps for amputees and their families. This is a subject very close to my heart. Over 25 years ago we highlighted a significant gap in the services available to people who were starting their rehabilitation journey following an amputation. I had met too many people who were struggling to cope with the challenges of this different life, beyond the clinic room. We introduced the LA’s Volunteer Visitor Programme where those with lived experience of limb loss could support other amputees adjust to this different life. Four years ago, with a generous grant from the National Lottery Community Fund, we redeveloped and relaunched the programme. This was just in time to deal with the devastating impact of the Covid-19 emergency, where the NHS closed almost all of the prosthetic services in the UK. This was arguably the biggest gap in support for amputees that had ever existed since the NHS was founded in 1948. However, our 95 trained, DBS-cleared and supported volunteers met that challenge.
I've personally supported hundreds of people who were having to cope and adjust to this different life, and in many instances this was a focus on the gaps in their unique rehabilitation journey. And this is a vitally important principle - every person living their life after limb loss is a unique individual. No two amputees are the same. So there are often no easy solutions. One patient experiencing an elective amputation procedure will meet their rehabilitation pathway objectives whereas the next patient, who originally presents with an almost identical prognosis, will struggle to rehabilitate. We are all unique!
The NHS provides some very good services to the limb loss community, but there are gaps in the service and it is also challenged in terms of being able to keep up with recent technological advancements in this field of specialised health care. However, I have long believed in the idea that disabled people should be, wherever possible, directly involved in decisions that will impact their daily lives. I work directly with NHS England as the only amputee member on the clinical reference group that covers prosthetic services, and I’ve recently linked up with Lord Mackinlay, the first quadruple amputee to ever sit in the House of Lords. These connections are of course very important and I was able to recently have a private meeting with Wes Streeting, the new Secretary of State for Health and Social Care, where we discussed issues that directly impact upon the levels of NHS support for people who are living with limb loss.
I've been associated with the LA for about forty years and I have never had such an opportunity. Accompanied by my colleague Tracy Ralph, Lord Mackinlay invited us to attend a meeting at the House of Lords to talk directly to Wes Streeting. We had 60 minutes, shared with a small number of other invited guests, to talk about the LA's services and in particular, the vital work of our Volunteer Visitor support service. The Secretary of State then
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**Limbless Association**
## **Trustees’ Report**
explained that due to recent personal experience, he certainly understood the value of peer-to-peer support. And this is a concept that is increasingly gaining credence and momentum within the NHS.
But this is just the beginning, and there is a lot more work to do. The LA is the only national charity supporting the civilian limb loss community in the UK, and it's very important that our voices are heard at the heart of government. I hope to continue my positive working relationship with Lord Mackinlay and to further advocate for the best services that will directly improve the lives of people in the UK living with limb loss. Our collective voices are vitally important in Bridging the Gap for the limb loss community across the UK.
I’d like to offer my heartfelt thanks all those who’ve supported and championed the Limbless Association through the challenges of recent years. We need your support more than ever to realise the charity’s ongoing developments and aims. 40 years and counting the Limbless Association looks forward to working with you and for you in 2024/2025 and beyond. Thank you!
## **David Rose, Chair of Trustees, Limbless Association**
## **Charity Achievements 2023 – 2024**
## **Context**
This has been an incredible busy period for the charity in terms of its services and projects. As well as relaunching our post-pandemic outreach and events programmes we’ve also developed a number of new peer led projects that all aim to ensure that _**no amputee need cope alone**_ . As a charity we promote and champion a learning culture for beneficiaries, members, volunteers and our team of staff team. We firmly believe that for those living with limb loss (and their families) information is power that can enable amputees to optimise access to and engagement with rehabilitation services.
Prior to the pandemic the LA had launched and was investing in the ongoing development of its Support and Connect national outreach programme the majority of which had been delivered at NHS prosthetics rehabilitation centres across the UK. We began the financial period 2023 to 2024 with NHS Covid protocols only just having been lifted with the lifting of those protocols being implemented to widely differing degrees across the sector. Therefore, rehabilitation services as we’d known them pre-pandemic would take much of 2023 to resume to previously recognised levels as would clinician and patient confidence in once again meeting in person.
While the charity had become adept at supporting with a range of online engagement opportunities we knew that this wasn’t an opportunity embraced by all. We were keen to restart our in-person Support and Connect outreach programme as soon as was feasibly possible. The outreach community hubs (group peer support) and helpdesks resumed at varying timeframes throughout 2023/24. We also had the opportunity to run pilot outreach sessions in several new locations too further strengthening our collaborations with NHS centres and hospital teams around the country.
The LA’s Volunteer Visitor peer support programme has gone from strength to strength with new volunteer cohorts being recruited with volunteer numbers reaching 95 in terms of active Volunteer Visitors and 22 prospective volunteers having registered their interest in joining the project. However, in order to ensure we continue to offer a quality driven service for service users, professionals and volunteers further recruitment was put on hold for the time being. We continue to offer a supported learning environment for our current volunteers whilst prospective volunteers can get involved with other charity activities to gain a better understanding of the LA’s aims. We run regular thematic events, informal online Hub chats and in person events nationally that are open to all amputees and their families/carers. All are welcome.
We have continued to work hard to further extend the reach of the service to amputees and sector professionals. Our outreach and service teams deliver presentations to clinical teams in person and online. These are opportunities for the VV service to be shared in detail and for clinicians to better understand how we deliver with the safeguarding of their patients and the volunteers being paramount. The recognition of the VV programme is growing with over half of our annual referrals being received from clinicians; physiotherapists, OTs, consultants, psychotherapists, solicitors, community support workers and navigators.
As we look to _**bridge the gaps**_ that exists in advice and information, in patient learning and peer connectivity to support improved health and rehabilitation outcomes for those experiencing limb loss, we are constantly seeking and listening to the voices of our community. The LA is ambitious and innovative but equally measured and pragmatic. We want the projects we design and develop to have meaningful impact. Everything we do starts with
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## **Limbless Association**
## **Trustees’ Report**
identifying the unmet needs of amputees, evidencing the need identified and the developing interventions that will aim to meet those needs. Our level of resourcing and the funds available are prohibitive however, we design projects that can be piloted and evaluated prior to scaling. In the last 8 months as well as delivering a pilot placebased Training to be an Amputee TTBAA programme (Essex), we’ve also designed and successfully delivered our new national Lunch and Learn programme (Amputee Learning Hub) and launched a project to support the unpaid carers of amputees (Amputee Carer Transitions). These projects are all user designed and led and are having a tangible impact on their respective beneficiaries. The impact of the TTBAA and Lunch and Learn programme will be shared later in this report.
The LA fosters positive relationships across the sector with our approach being one of influence and collaboration. Our ongoing arrangement with Mayflower Community Hospital MCH – the main Essex Prosthetics Centre – highlights what can be achieved through such collaborative approaches. The charity is based at MCH having been allocated a small office space. We also deliver frontline support to MCH patients via the LA Kitchen (reception tea bar) as well as being on hand for referrals from the MCH prosthetics team. Being able to place the LA at the heart of the rehabilitation pathway has been invaluable in offering broader support to patients and their families as well as supporting our learning as an organisation. We’re enormously grateful to Sue Patterson, Centre Manager, and her team, for championing this progressive development and to NELFT NHS Foundation Trust. We look forward to exploring further coproduction opportunities for the benefit of the Essex limb loss community.
The charity has been fortunate to be in a position to designate reserves to navigate the challenges of the pandemic and support the growing needs of our national community through ongoing expansion and improvement of services. However, it has not been immune to the external challenges and their impact. The increased need for our services due to the limited clinical access during the pandemic and beyond together with the onset of the cost of living crisis, this has without doubt continued to be an incredibly difficult and intensely busy period. Many of those we support face multiple challenges; emotional, physical, mental health, financial. Lives have been changed forever and the building blocks of recovery can seem relentless and unattainable. Those who access our services in the early stages of limb loss (or pre-amputation) are confused, frightened and vulnerable.
The outcomes we can report from existing projects that we’ve redeveloped and the new projects we’ve designed are proving that they have the potential to meet a variety of unmet needs for amputees; advice and information, education, empowerment and resilience, emotional support and peer connectivity, tackling health inequalities and isolation. However, to deliver such projects and services requires funding and resources. Income generation is a key focus and an equally significant challenge. The cost of living crisis continues to adversely affect levels of individual giving as people’s disposable income diminishes and grant funding opportunities are reducing, pausing and becoming increasingly more competitive. However, we know our work is needed as many amputees continue to face their limb loss alone, frightened and unable to see a future.
In June 2023 we were delighted to be awarded funding from the Julia and Hans Rausing Trust to support the Volunteer Visitor programme developments. Their grant award funded the ongoing delivery of the programme and we’re hugely grateful for their support. We were extremely saddened to hear about the passing of Julia Rausing early in 2024 with the Trust being renamed the Julia Rausing Trust in memory of a truly inspirational and transformational philanthropist.
We simply can’t do our work without the support of our funders, sponsors, members and supporters. We wholeheartedly thank them all for recognising and valuing the impact of our work. The LA is also very fortunate to have an incredibly loyal and passionate volunteering community, Trustees and staff team who despite the challenges continue to work with commitment and energy.
## **Limbless Association Activity Review 2023/2024**
Through our multi-stakeholder engagement – service users, members, volunteers, sector professionals - we know that there continues to be a gap in the support available to amputees in the rehabilitation pathway. Those experiencing limb loss must navigate multiple and complex challenges through a rehabilitation process that can be long and overwhelming. The negative impact on physical, emotional and mental health wellbeing is considerable and requires a range of strategies and interventions _beyond the clinic_ room to optimise rehabilitation outcomes. Members, service users and their families tell us that there is a lack of information and support at all stages of the early rehabilitation pathway. The Limbless Association’s developing services and projects aim to work collaboratively with clinical teams to fill the gaps where additional non-clinical support is needed to realise optimum rehabilitation outcomes. Central to the LA’s work is supporting amputees to rebuild lives in order for
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**Limbless Association**
## **Trustees’ Report**
individuals and their families to thrive beyond limb loss. The LA is a user led charity with its aims and work being informed and shaped by those with lived experience; our members, volunteers, service users and many of our staff team. We consult, we listen, we respond, we innovate.
## **Strategic Representation and Engagement**
As a user led charity, the Limbless Association has since its inception represented the limb loss community in national and local strategic forums, recognised as the leading civilian charity in the UK supporting those affected by limb loss and limb impairment. It is a privilege for us to build on this heritage and continue to be involved in this important area of work that enables us to represent the collective voice of our members, service users and the wider limb loss community. This work also provides us with the opportunity to ensure that we build relationships with key sector decision makers and influencers.
The charity is a member of and attends the following groups:-
IC2A; Member of the PIP Policy Forum; Rehabilitation and complex disability and spinal cord injury CRG; Prosthetics Review Steering Group; Prosthetics Review Clinical Working Group (Service Specification); East of England Trauma Network; Trauma East Voices; APIL – Alliance for Injured People; Specialised Healthcare Alliance; Chelmsford Area Access Group (CAAG). Community Rehabilitation Alliance England (Chartered Society of Physiotherapists); Cornwall Amputee Pathway Group.
## **Partnerships**
The Limbless Association continues to forge clinical and professional partnerships across the sector. We are building strong relationships with NHS partners in acute care, surgical and rehabilitation settings. We are also fortunate to work with and be supported by private sector providers. The LA Limb Loss Legal Panel ensures the LA community is supported by an incredibly proactive and engaged legal panel of experts. Increased awareness of our services continues to realise a growth in related sector referral partners that include wider sector stakeholders; case managers, social prescribers and community navigators.
The benefits of partnership working can be clearly demonstrated through our outreach work with the rehabilitation centres and specifically with our developments at Billericay, Bristol, Manchester, Hull, Cardiff, Swansea, Preston, Leeds, Birmingham, Belfast, Gillingham, Nottingham, Sheffield and Wolverhampton with the delivery of LA Helpdesks and Hubs.
Where there are collaborative opportunities with other charities in our sector, we aim to support these for the benefit of the limb loss community. We also consult non-sector charities operating in the field of frontline support in the disability and healthcare sector.
## **Research**
The LA is keen to support medical research in areas of prevention, service improvement, surgical advancement and prosthetics. We are passionate about the need for patient centred research across the limb loss sector. We are approached by many researchers requiring support, either organisational or member participation, and will always support where we feel it’s appropriate and if we’re able to do so in terms of those projects that might best serve our community.
Research projects the LA is currently supporting:
## PLACEMENT
Research Lead – Dave Bosanquet, Vascular Consultant, Aneurin Bevan UHB collaborating with Cardiff University. Aim: Improvement of post operative pain management for amputees. DUSTER
Research Lead - Ankur Thapar, Vascular Consultant, Basildon Hospital (Mid and South Essex Hospital Trust) in collaboration with Anglia Ruskin University.
Re: Proving efficacy (amputation reduction) of screening programme for vascular patients post initial intervention. HAMLET
Research Lead – George Smith, Vascular Consultant, Hull University Hospital Trust.
Re: Evaluating Quality of Life Outcomes for Through Knee Amputation compared to Above Knee Amputation.
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**Limbless Association**
## **Trustees’ Report**
## **LA Services and Projects**
## **We aim to ensure that NO AMPUTEE NEED COPE ALONE**
Since the charity undertook a major strategic review in 2017 (further reviewed and refreshed in 2021) its focus has been on developing services and projects that have an early intervention approach positioning the LA as a provider of frontline information and support to amputees and their families Once discharged from hospital and quite often before, dealing with the practical and emotional impact of limb loss - short, mid and longer term - is a complex and very personal unpredictable journey for the individual and their families. It can be difficult to look and move forward with hope and optimism. Just contemplating a life after amputation can be too overwhelming. We believe that the LA’s services and innovations can offer a comprehensive support solution that compliments the clinical pathway. In so doing our activities support amputees, their families and the medical teams caring for them. As our work streams develop our activities are increasingly focusing on education and empowerment and for this reason we’ve launched our Amputee Learning Hub that will see various project innovations to support vital learning for the limb loss community. Receiving timely information and support from a trusted and credible source is vital when facing the complexities that limb loss presents. The LA aims to be practical, responsive and innovative with our service and resource development to truly reflect and fulfil the needs of those experiencing such life changing circumstances. Four core strands of activity have been identified to support our aims in providing non-clinical support pre-and post-amputation:
## **> INFORMING > ADVISING > SUPPORTING > CONNECTING >**
## **Informing**
We are working hard to ensure that we continue to be informed about rehabilitation service provision and developments so that we can guide, signpost and update across a breadth of topic and query. Improving widespread accessibility to important early information is paramount to our strategic and operational aims.
## **Advising**
We are developing our advisory capabilities and capacity by growing our expertise and ensuring professionalism together with protocol is integral to strengthening this vital area of our work.
## **Supporting**
We are developing projects and programmes that will offer practical and holistic user informed support. This is an exciting area of work and we will continue to collaborate with our members and other stakeholders to identify their needs and how our future plans can support them.
## **Connecting**
We will continue to raise awareness of the issues and raise the profile of the LA as a champion of those issues. We will seek multi-stakeholder engagement opportunities and we will continue to develop and deliver our own programme of events aimed at bringing together amputees and sector professionals for shared learning (informing, advising, supporting) and networking opportunities.
## **OUR SERVICES, PROJECTS AND IMPACT**
## **LA HELP DESK – Advice, Information and Signposting**
The LA helpline provides a first point of contact support for amputees, friends, families, carers and healthcare professionals. The enquiries we receive cover wide ranging topics about all aspects of limb loss, pre- and postamputation, including welfare rights, housing, social care, prosthetic services and peer support. We continue to build our knowledge and information sources to enable the team to offer a broad spectrum of support and signposting. We aim to offer the highest quality information, advice and support to empower amputees and their families to navigate the multiple challenges faced pre and post-amputation. With the challenges in social care provision and fragmented on-discharge community support we’re experiencing increasing numbers of amputees contacting our helpline who present with ever more complex issues. As a small charity with limited resources this is an ongoing challenge in terms of the limitations of our capacity to meet this growing need. During this period our team have supported over 3300 amputees and family members. While our support targets new amputees we are also supporting significant numbers of those who are all at varying stages of the limb loss pathway.
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**Limbless Association**
## **Trustees’ Report**
The top 6 topics those contacting us what to know more about:
- Finance - Welfare Rights
- Aids and adaptations
- Housing
- Prosthetics rehabilitation
- Access to legal advice
- Peer support – accessing the LAs Volunteer Visitor programme
We provide information that empowers individuals to be proactive in their rehabilitation to optimise their personal goals and outcomes.
_**“I was expecting the possibility of an amputation and clinical advice I was given was good. On discharge I really felt I was cast adrift and left to my own devices how to proceed. There was nobody in a supervising role for my ongoing progress. There was no information pack or advice. I proceeded with advice from friends, family, my own will power and the LA.”** LA service user_
## **LA SUPPORT AND CONNECT OUTREACH**
Since launching Support and Connect in 2018 and having navigated a virtual outreach contingency throughout the pandemic, we are committed to developing the LA’s regional and local support offer. Many amputees and their families are seeking in-person support and safe spaces to connect with peers to help them navigate the challenges they face. Our outreach team (all with lived experience of limb loss) have had a busy year.
## **Support and Connect achievements:**
- Over 1300 supported
- 433 attending in-person Hubs and Helpdesks
- 208 supported at the LA Kitchen
- 135 supported at events
## **Key aims:**
- Reduce the isolation that amputees experience
- Improve amputees’ knowledge regarding recovery and life after limb loss
- Build a local and regional peer community.
- Introduce amputees to activities and other experiences to improve their wellbeing and quality of life
- Provide development and employability opportunities for amputees through volunteering pathways and learning activities.
## **Key Outcomes:**
We asked outreach participants to tell us about their experiences in accessing LA Support and Connect activities:
- 463 felt more connected with the limb loss community and less isolated
- 249 had a greater awareness of services available to them
- 263 reported an improvement in their wellbeing
- 269 had a greater knowledge of the rehabilitation pathway
- 429 accessed involvement and development opportunities
## **Key outreach activities:**
- Regular in person Hub sessions
- Online Hub Chats
- Virtually Speaking online thematic events
- LA Kitchen (MCH Billericay)
- Amputee Lunch and Learn in-person (2024)
- Amputee Learning Hub online (2024)
- LA Helpdesks (onsite at rehabilitation centres)
- Referring to LA Services Support
- Signposting to LA resources
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## **Trustees’ Report**
- Signposting to local agencies (needs appropriate)
- Welfare calls (one to one support)
- Delivering and attending local and regional engagement opportunities
- Represent the LA at local and regional level (sector and related)
## **Outreach locations in 2023/24:**
Belfast, Billericay, Birmingham, Bristol, Broomfield, Cardiff, Corringham, Gillingham, Leeds, London, Manchester, Nottingham, Preston, Sheffield, Southend, Wolverhampton.
In recent years support and Connect activities have been supported by the National Lottery Awards for All programmes in England, Wales and Northern Ireland. We’re enormously grateful to the players of the National Lottery for their generosity and support. It has enabled us to further develop the outreach project during 2023/24, building on the learning of recent years. This now sees us refreshing our outreach delivery model with a renewed focus and some ambitious plans for 2024/25 to develop a national Amputee Network of support and development opportunities on the ground for more beneficiaries.
## **Virtually Speaking online thematic support sessions**
Launched in 2020 in response to the pandemic restrictions, Virtually Speaking has become an integral online service. This platform offers opportunities for sector professionals to be involved in our work and support our members and service users. It has provided our community with access to expert advice across a range of subject. Participants can hear from and engage with sector experts as well as accessing wellbeing sessions all from the comfort of their own homes. Topics delivered during this period included:
- The Motability Scheme (Motability)
- Wheelchair services (AJM Healthcare)Getting back to driving after amputation. Presented by HertsAbility.
- Direct Socket Transfemoral socket solution. Presented by Ossur Academy.
- Upper Limb Solutions. Presented by Ottobock.
- Psychological Wellbeing after limb loss. Presented by Dr Tajinder Rai.
_**“Great to have the chance to hear information from a professional with the chance to ask questions and in response be given facts on a professional level. Great to be given this opportunity in a safe and secure platform as well as virtually socialising with other amputees.”**_
_**“The Limbless Association gave me the tools to realise there was life after becoming an amputee.”**_
We’re enormously grateful to the professionals and companies who contributed to the Virtually Speaking programme, providing invaluable insight into key topics together with invaluable Q and A opportunities for our community enabling directly access to expert support.
## **LA VOLUNTEER VISITOR – one to one peer support service**
Limb loss brings unique challenges, so sometimes you need to talk to others who have been through similar experiences. That’s the premise of the Volunteer Visitor programme – _**amputees supporting amputees**_ .
## _**“I wish I’d had someone like me to talk to about my traumatic experience when I became an amputee.” LA Volunteer Visitor**_
We believe that having access to a quality focused peer support service is vital to all amputees as part of their early rehabilitation pathway and it’s this belief that has driven us to further develop the LA’s longstanding peer support offer, Volunteer Visitor. The National Lottery Reaching Communities funding enabled us to realise our vision of creating a robust service model of peer support for the limb loss community.
It is also our passion that our volunteers, who support with their lived experience, have access to the good quality training, development and ongoing support in their roles. The funding has enabled us to provide enhanced volunteering opportunities for amputees who are further along their rehabilitation journey and know how important it is for newer amputees to speak to someone who genuinely understands. Some of our volunteers are motivated by having received and benefited from peer support themselves and others by the fact that they didn’t but would have found it valuable. LA Volunteer Visitors are supported with a variety of training, development and peer networking opportunities. Due to the level of training and support, our volunteers are able to offer high quality peer mentoring that both patients and professionals can access and trust.
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**Limbless Association**
## **Trustees’ Report**
Despite the 3 year funding from the National Lottery coming to an end in March 2023 (including a 6 month extension due to the pandemic) the LA continues to deliver the model established. Our Volunteer Visitor peer support is a key service for the charity. In June 2023 we received funding from the then Julia and Hans Rausing Trust (now Julia Rausing Trust) towards the costs of the ongoing development of the VV programme.
This VV peer support programme delivers a one to one peer support service as well as training and supporting volunteers with lived experience of limb loss to provide peer support to newer amputees. The programme seeks to promote rehabilitation and recovery for amputees, as well as reducing isolation and promoting confidence, reducing stress and anxiety and ensuring that No Amputee Need Cope Alone. Through this programme, amputees become more informed, connected and empowered in their rehabilitation. This is a national programme and supports amputees living across the UK. The programme has trained a small and growing number of family peer mentors. This means that we are also able to support the loved ones of amputees.
Throughout the year, we continued with the day-to-day delivery of the Volunteer Visitor programme. This includes coordinating the matches and visits, volunteer recruitment, training and support. We have also been busy promoting the project within hospitals, limb-centres, rehabilitation centres and with other agencies (such as social prescribers) throughout the UK, to encourage referrals to the programme. Promotion is also via our social media channels, via our website and through our charity partners and stakeholders.
## **Key Aims and Developments for the VV programme**
## **Aims**
- Support more amputees to fulfil their potential
- Learn about peer support as an intervention
- Evidence outcomes and measure the impact
- Develop a robust service model
- Create a comprehensive peer support training package
- Be used to influence national and local policy relating to amputees
- Develop greater connections with the sector
- Help evidence the need for continued investment in the programme
## **Developments**
- A robust service model of amputee peer support
- A safer recruitment process
- Recruitment, induction and training of over 80 Volunteer Visitors
- Comprehensive volunteer development programme with opportunity to achieve the VV Award
- Peer networking and recognition opportunities for volunteers
- VV service specification and service framework
- Comprehensive policies covering all aspects of the service and volunteering programme
- Project monitoring and evaluation tools to measure and report impact of the project – for service users and volunteers
- VV programme integrated into the LA’s Service User Pathway
- New VV resources, including posters and flyers, information videos, social media content and assets and stakeholder presentations
- Raised awareness of the VV programme – peers support and volunteering – through continued promotion to key stakeholders and referrers across the UK.
## **Key achievements for the project in 2023/24:**
- 389 referrals
- 95 active Volunteer Visitors
- 22 prospective VVs
- 685 volunteering hours recorded
Following support, amputees report feeling better informed about amputation, recovery, living day-to-day life with limb loss and the services and support available to them as amputees including those provided by the LA.
We ask service users to complete a self-assessment form prior to their visit, again following their visit and then five weeks after their visit. This helps us track the change in knowledge and emotional wellbeing and ensures that service users can provide us with additional feedback. We also ask our Volunteers to complete a report ‘post visit’ so that we can understand any trends with regards to the issues discussed/needs arising from our service users.
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## **Limbless Association**
## **Trustees’ Report**
Finally, we ask our Volunteers to complete self-assessment forms both pre- and post-training. This is supplemented by information gathered through coffee catch ups, focus groups and supervision forms.
Our ongoing monitoring and evaluation shows that our Volunteer Visitor service makes a positive difference to amputees’ knowledge and awareness around:
- amputation
- recovery and what comes next for them
- living day to day life with limb loss
- the services and support available to them as amputees.
**Key outcomes for service users:**
- 92% of our service users say that they feel more supported following their visit.
- 87% feel more connected with others
- 81% say that they feel less stress in relation to their limb loss
- 75% feel less isolated.
Our service users also comment as to the impact of the service, for example: _**“The man I’ve spoken to is hopefully myself in a few years’ time, more confident and stronger physically. He makes me realise that there is hope even on down days.”**_
## **Volunteer Visitor case study**
We received an enquiry from a patient who was due to undergo amputations on both her arms (at the wrist) and both her feet due to sepsis complications. She was, understandably, very worried about not only the procedure but how she would adapt to life as a quadruple amputee. We were able to match her with one of our Volunteer Visitors and arranged for the visit to take place via Zoom so that the patient could see that our Volunteer had a very similar level of limb loss. Our Volunteer was able to demonstrate that while life as a quadruple amputee was challenging, it was still possible. She spoke about her life following amputation, how she set herself small goals each day and now, four years down the line, is driving her own adapted vehicle. The patient was visibly relieved and said that she felt less anxious about her recovery and life as a quadruple amputee. The patient had been supported during the call by a nurse who, towards the end of the call, said “Amputees can give you the information that we simply can’t.”
_**“My volunteer visit coincided with a period where I was feeling relatively low and quietly resigning myself to wheelchair life. The visit and the enthusiasm of my visitor gave me a real “pick me up” just when I needed it and opened my eyes to the possibilities that are there if I continue to push myself.”**_
## **Impact for Volunteer Visitors**
Our VV programme also leads to benefits for our volunteers, with volunteers demonstrating that following training, they have improved awareness of their own limb loss, their recovery and living day to day life with limb loss. With 95 Volunteer Visitors we have capacity to support more service users through our VV programme. Patients can self-refer to the service and there is also an online referral form for clinicians. We will continue with the promotion of the programme throughout the UK through our outreach and engagement teams.
In order to provide a valuable volunteering experience for our volunteers we are developing new volunteer roles within the organisation. These roles will ensure that our current cohort of Volunteer Visitors can use their skills and training to support amputees at face-to-face support groups or via other engagement pathways. We have also trained some of our Volunteers to become LA Ambassadors, so that they can represent the LA at external events. We are also planning to extend our Volunteer Pathway, so that we can offer volunteer training and skills development opportunities for amputees who are earlier on in their recovery journey.
All of our Volunteer Visitors told us that they would recommend the VV programme to other amputees.
## **Outcomes for volunteers**
- 100% said they felt empowered to support others
- 96% said they felt more confident in their everyday life 96%
- 80% said they felt more supported in their own limb loss journey
- 88% said they felt more connected to the limb loss community
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**Limbless Association**
## **Trustees’ Report**
_**“Being a Volunteer Visitor with the LA is an incredibly rewarding and enriching experience. Not only are you helping others who are going through what is often a hugely daunting and traumatic time, but you learn so much yourself, with the opportunity to develop your own skills further due to the excellent training provided by the LA. I’d recommend it to any amputee wanting to use their experience to give something back to others on their journey through limb loss.”**_
LA Volunteer Visitors are incredibly dedicated to the role, the programme and the charity’s aims. We are incredible grateful for their time, commitment and unfailing support of the Volunteer Visitor programme and they LA. They are a very special group of people who have enabled us to realise a model of peer support the impact of which is tangible. Heartfelt thanks to them all.
The Volunteer Visitor programme developments have only been possible with the support of the generous funding from the National Lottery Reaching Communities Fund. We’re enormously grateful to the National Lottery and its players for their generous support. This funding is truly changing lives and helping the LA to ensure that _no amputee need cope alone_ .
Volunteer Visitor and LA Chair of Trustees David Rose believes it’s as important as it’s ever been for amputees to have access to high quality peer support.
_**“It’s natural to feel lost in the early days of limb loss. That’s why the LA’s Volunteer Visitor service exists, providing support and advice to help amputees move forward. For our Volunteer Visitors it’s a very rewarding activity, as it’s a chance to give something back.”**_
## **AMPUTEE LEARNING HUB**
## **Training to be an Amputee**
Whether you or a loved one has experienced limb loss or is about to, it can be frightening, overwhelming and confusing in equal measure. As a user-led charity, we know how tough this can be. Everything we do is informed and shaped by our members, volunteers and service user voices. Our community have told us that there needs to be clearer, comprehensive support and information to better support the individual and their loved ones, especially in the early days and months following amputation (and pre-amputation. We believe that being better-informed leads to improved recovery and rehabilitation outcomes with the potential to reduce health inequalities experienced by many amputees.
At the end of 2022 we consulted on and developed a new initiative – the LA’s Amputee Learning Hub ALH. ALH aimed to realise the development of a number of learning opportunities that would tangibly contribute to the empowerment of amputees to navigate the challenges of living with limb loss. These initiatives would look to answer what, when, how and why. Early in 2023 the first **Training to be an Amputee** online programme was devised and developed for amputees and their families. Experts from across the sector contributed to the 8 weekly sessions that were also supported by our Volunteer Visitors who offered peer insight on a range of topics.
An average of 35 amputees attended each session along with family members and sector professionals. Key outcomes measures:
89% felt well informed about amputation 100% felt well informed about recovery and what comes next 78% felt well informed about day to day life with limb loss
70% felt well informed about the services and support available
60% felt more confident about their rehabilitation journey
39% felt less isolated
42% advised they were experiencing less stress/anxiety in relation to their limb loss 67% felt supported in their limb loss journey
## **TTBAA Participant feedback**
**“** _**An invaluable programme where you can pick what subjects are of the most interest individually with the convenience of being able to participate online and interact with other amputees.”**_
Having delivered successfully online in September 2023 the Limbless Association received funding from the Mid and South Essex Mental Health ‘Inequalities Programme’, administered by Essex Community Foundation. The grant awarded was to support the production and delivery of a place based programme of Training To Be An
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**Limbless Association**
## **Trustees’ Report**
Amputee in Essex; a bespoke programme for amputees and their families which aims to empower and support amputees who may be struggling particularly in the early stages of their rehabilitation.
## **The programme aims to reduce health inequalities, through:**
- Information and support to enable amputees and their carers/family to better manage their own mental health and wellbeing
- Guidance about support services available.
- Assistance and advice to family/friends, so that they are more empowered to support their loved one throughout their rehabilitation.
- Access to wellbeing interventions.
## **Training To Be An Amputee (TTBAA) anticipated outcomes:**
- Improve recovery and rehabilitation for amputees, through the provision of information and support to contribute towards successful rehabilitation.
- Support the mental health needs of amputees, through mental health information and support, and wellbeing guidance.
- Reduce the likelihood of re-admittance to hospital or secondary amputation, through supporting amputees to manage their physical health and wellbeing, and empowering them to manage long-standing health conditions such as diabetes.
## **TTBAA place based programme delivery**
The LA delivered five Training To Be An Amputee programmes across the delivery area:
Billericay, December 2023/January 2024
Southend, February-March 2024 Chelmsford, March 2024 Billericay, May 2024 Southend, July/August 2024
## **TTBAA place based programme outcomes**
_Learner experiences_
We asked participants to identify some of the issues they were struggling with:
- 59% of participants said that they were finding day-to-day life with limb loss difficult/finding caring for someone with limb loss to be difficult.
- 17% said that they were struggling financially since their limb loss
- 34% said that they were struggling with their mood
- 50% said that they were unsure about recovery timescales and rehabilitation
- 58% said at they needed more information about life as an amputee.
91% of service users identified that they were interested in finding out more about support that they could access (both financial and practical) and support from the LA. 75% identified that they wanted to speak with and learn from other amputees by accessing the LA’s Volunteer Visitor peer support service. Training To Be An Amputee has had a statistically meaningful positive change on the health and wellbeing of 83% of programme participants.
_**“I always look forward to coming to Training To Be An Amputee. We’re all having the same problem, but there are people who are further ahead of me in their recovery. I now have goals like the volunteers as they explained things to me and they helped me. It’s made me have more strength and hope to achieve. If I stayed at home instead of coming to the sessions, I know my family would help me, but I would have struggled. A lot of things through the course were enlightened to me. I feel very close to the “LA Family”. I don’t have many friends, as I moved around a lot.”**_
_**“This course has made me realise that I’m not alone, that I’m not the only person like this. The LA completely changed that for us – I’m not sitting there alone.”**_
_**“One amputee has told me ‘You don’t need Training To Be An Amputee! Once you’re an amputee, you’re an amputee!’ I told him that actually, I did. I knew nothing about limb loss, and I had an elective surgery. I thought I knew it all before my operation and that I had prepared. But I didn’t. I dread to think about the situation I would have been in if it wasn’t for the LA.”**_
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## **Limbless Association**
## **Trustees’ Report**
## **What we’ve learned**
Training To Be An Amputee has led to us understanding the needs and challenges relating to carers/friends/family members of amputees. Amputees experience additional challenges for involvement; while this project has sought to address amputees’ needs, we know that amputees still face barriers in attending. Those who were unable to attend cited transport issues/unable to leave home alone (37%); that they found it too overwhelming to attend (11%); that they were unwell on the day (20%); that they had other medical appointments to attend (16%) and some had work commitments (16%).
Our evaluation data tells us that Training To Be An Amputee can be a crucial early engagement programme that can provide unparalleled support for new amputees. We believe that every amputee could benefit from the programme. We’ve learned that place-based Training To Be An Amputee has improved access to services for amputees. For example, TTBAA sessions delivered in the gym at Southend Hospital has enabled attendees to have early engagement with physiotherapists and OT’s based at the Hospital. We’ve also been able to encourage and support other service users into the programme. TTBAA has also helped us to develop relationships with sector professionals in local hospitals; these have been key in supporting/facilitating referrals into the programme.
We wish to extend our sincerest thanks to the funders of Training to be an Amputee – Essex Community Foundation (MSE NHS Partnership Trust Health Inequalities Fund)(Mid and South Essex) and The Postcode Places Trust (Essex).
## **Amputee Carer Transitions**
Delivering Training to be an Amputee in Essex also highlighted to us the challenges that carers experience in relation to their loved one’s limb loss. In January 2024 we applied for and in March were successfully awarded funding from Essex County Council to develop the LA’s carer support programme – Amputee Carer Transitions ACT. ACT will aim to provide better support for amputee carers. ACT will address and meet the needs of amputee carers. Increasing visibility of this group, improving access to information, support, peer networking and development opportunities. Leading to amputee carers being more informed and more resilient to support their loved ones in the long and challenging rehabilitation pathway. We look forward to reporting on our progress in 2024/25 and further information about this project will be placed on the LA’s website. We’re extremely grateful for the support of the Essex Community Carers fund (ECC) in supporting us to meet the needs of those that are often overlooked in the limb loss rehabilitation process.
## **Amputee Learning Hub – Lunch and Learn**
In January 2024 we received funding from Awards for All England to further develop our Amputee Learning Hub concept. Amputee Learning Hub ALH will ensure that all amputees across England will have access to either online or face-to-face peer-led courses which address health inequalities. Programmes within our Learning Hub will: improve amputees' rehabilitation and recovery through access to quality information; advice and guidance; reduce isolation for amputees; improve confidence; motivation; and health and wellbeing.
A key initiative of the LA’s Amputee Learning Hub portfolio is the Amputee Lunch and Learn programme. Lunch and Learn aims to provide amputees, their loved ones and professionals with accessible, supportive and informative sessions which improve awareness of limb loss, rehabilitation and recovery. Each Lunch and Learn session meets for approximately 2.5 hours and follows a set format, including a speaker, time for facilitated discussion and peer support over a sandwich lunch. Lunch and Learn was developed in the spring of 2024 and was piloted in venues across the UK, including Preston, Billericay, Manchester and Cardiff. Since then Lunch and Learn has also been delivered in Oxford, Leeds, Bristol and Hull.
Most Lunch and Learn sessions were attended by on average 30 people (this includes amputees, their carers/loved ones, volunteers and professionals). While predominately focused on amputees within the earlier stages of their limb loss, 30% of those attending the programme had lived with limb loss for over 10 years. This demonstrates the continued need for service provision and support for those who still feel affected by their amputation
Following each Lunch and Learn event, attendees were sent a follow-up email containing a link to an online survey. Responses to the survey have been utilised to ascertain the benefits of the Lunch and Learn programme.
## **Impact for Lunch and Learn participants**
Of those responding to the survey: 79% said that Lunch and Learn helped them to feel more confident. 89% said that the session led them to becoming more informed about limb loss and the sector. 59% said that they felt more informed about their own limb loss.
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**Limbless Association**
## **Trustees’ Report**
93% said that they felt more informed about the LA and its services. 71% said that they felt more supported regarding their own limb loss. 57% said that they felt more accepting of their own limb loss. 85% said that they felt less isolated as an amputee. 88% said that they felt more inspired and motivated to achieve for themselves and for others. 96% said that they felt more connected with others affected by limb loss and the limb loss community.
Attendees also commented that the Lunch and Learn programme made them _**“feel less alone”**_ and _**“have a purpose”.**_
## **Impact of Lunch and Learn for volunteers**
Four volunteers completed the survey. They highlighted that the event made them: More confident in their volunteering role (100%)
More informed about limb loss and the sector so that they could better support other amputees within their volunteering role (100%)
More informed about the LA and its services (75%) More inspired and motivated to achieve for themselves and others (100%) More connected with others affected by limb loss and the amputee community (100%)
## **Volunteers comments included:**
_**“I found it to be really interesting listening to how other amputees deal with their disability and I enjoyed the social aspect. Everybody was very friendly and willing to talk about how they cope day to day.” “I felt like I’ve passed some of my knowledge onto other people who are just starting their limb loss journey.”**_
## **Lunch and Learn participant views and feedback**
Those attending were incredibly positive about the event, recognising the solidarity between amputees, the opportunity to meet, learn and socialise with other amputees and share experiences. All of those attending indicated that they were very likely to attend another Lunch and Learn event.
_**“It was fun, informative and great to feel accepted for myself rather than feeling defined by my limitations.” “I wish I had found it sooner as I had three years feeling isolated with my first amputation.”**_
_**“I absolutely found it really knowledgeable and interesting and it has really helped me prepare for what is to come after my surgery.”**_
_**“I had an MDT scheduled for the following week and had been worried about it. The presentation showed me that MDTs are a regular part of my rehabilitation.”**_
## **Health and Wellbeing**
## **Keep it Moving (Delivered by Hull University Sports and Science Department)**
The Keep it Moving Programme is an exercise programme that has been created to remove the barriers associated with exercise for amputees. This industry leading programme has helped countless amputee's gain fitness, confidence and friendship with like-minded people in Hull, Yorkshire and Nationally. It’s been designed by academic staff from the School of Sport Exercise and Rehabilitation Science in collaboration with staff from Hull Sport. Four sessions are offered each week, two in the gym at the University of Hull and two via Zoom to amputees from all around the UK. The zoom sessions have been supported by the LA since autumn 2023 under a collaborative agreement with Hull University. Ensuring good physical and mental health and wellbeing are vitally important for amputees to optimise their rehabilitation outcomes and the LA wholeheartedly supports the aims of the programme. We have seen firsthand the difference the programme has made to those who’ve accessed it. We’re excited to support the wider reach of the programme to LA members and service users across the UK in 2024 and beyond. We look forward to working with Hull University School of Sports and Science to realise this aim.
## **LA** I **nformation Resources**
Lack of information in the early stages of limb loss is a common issue that’s raised by amputees and their families. Having awareness of and access to support beyond clinical care is essential to ensure that those affected can be better informed and more holistically supported. The LA produces a range of resources including service specific posters and leaflets that are distributed to all UK rehabilitation centres, vascular and trauma departments. Some of these departments produce their own patient information packs in which LA resources are included. If appropriate to the individual concerned we also signpost to the LA’s website which contains a comprehensive dedicated resource area as well as more detailed information about the services we are able to offer.
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**Limbless Association**
## **Trustees’ Report**
www.limbless-association.org LA literature is also distributed at our outreach Hubs and Helpdesks as well as at the various sector events we attend across each year.
## **Access to legal advice - The Limbless Association Limb Loss Legal Panel**
The Limbless Association established the Limb Loss Legal Panel; a consortium of leading law firms in the UK, specialising in personal injury, clinical negligence and legal cases where catastrophic injury and amputation occur. Its aim is to provide Limbless Association members and service users with the highest quality legal advice, on a free initial-consultation basis. We continue to promote the importance of early and expert advice as well as highlighting freedom of choice.
We wish to thank our panel for the support they have offered our service users and the charity throughout 2023/24. As well as their generous sponsorship, the panel members individually support with fundraising, event hosting, - - volunteering and mentoring for which we are extremely grateful. https://limbless association.org/legal panel/
The LA legal panel support the outreach team at Hub sessions in their areas and we thank them all for their time, compassion and expertise to support those experiencing the challenges and trauma in the early days of limb loss.
The following legal panel members have provided hosting and support at LA Lunch and Learn sessions: **RWK Goodman, Hudgell Solicitors, Enable Law, Stewarts Law, Hugh James, Bolt Burdon Kemp, Stephensons Solicitors and Hodge Jones & Allen.** Sincerest thanks to them all.
## **LA’s annual O2 Climb**
In September 2023 we were delighted to have the support of **Anthony Gold Solicitors LLP** with their sponsorship of our annual O2 climbing challenge. Over 30 climbers supported on the day by the team from Anthony Gold and the LA team walked over this iconic landmark. It’s a tough climb for many of the fittest amputees and we had all levels of ability taking part. Everyone made it over in good spirits and a huge amount of camaraderie and peer support. Thank you to Anthony Gold Solicitors for making it possible and to those who raised funds in the process.
## **LA Hubs at Fieldfisher**
For several years Fieldfisher have supported the charity to host central London Hubs for members and service users. Their wonderful venue space overlooking the Thames provides a great opportunity for peer networking and support. Sincerest thanks to Jennifer Buchanan and the Fieldfisher team for ensuring each session sees LA Hub guests receive the warmest of welcomes. Opportunities to connect, take part in a wellbeing session followed by coffee and cake in such lovely surroundings is a real treat.
## **LIMBLESS ASSOCIATION MEMBERSHIP**
Membership of the LA continues to be free for all amputees as we believe that there should be no barrier to benefiting from being part of our community. Amputees join the LA at varying stages of their limb loss pathway. With a growing team, increased numbers of volunteers together with project and brand developments the LA is increasingly more visible. Amputees, their families and professionals are finding out about our services via the internet, the LA’s magazine StepForward, the engagement activities of the LA team and word of mouth. Due to this membership numbers are growing and stand at c. 2600. We are extremely grateful to those members who make regular donations to the charity and fundraise to support our work. We hereby extend our warmest thanks. Growing LA membership remains a key aim to in turn grow our collective voice. We will also always ensure that we are truly representing our member’s views by consulting regularly and widely.
Our members voices shape and influence our services:
_**"As an amputee, the rehabilitation doesn't stop - it just changes over time. As amputees we have to constantly adjust and we have different needs over that timeframe.”**_
## **LIMBLESS ASSOCIATION AIMS AND SOLUTIONS**
## **Key unmet needs identified and the problems the work of the LA aims to solve:**
1. Lack of information pre and post-amputation.
2. Peer to peer support was identified as very important to amputees as they begin their limb loss journey.
3. Local advice and support needed. A greater geographic presence from the charity and its services.
## **The solutions the LA is developing:**
1. Information resources in rehabilitation centres and hospitals.
2. The LA has an experienced advice and information team ready to support amputees and their families to navigate a range of queries and topics.
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**Limbless Association**
## **Trustees’ Report**
3. Building strong key stakeholder relationships to integrate our services into the rehabilitation pathway.
4. The LA is innovative in developing and piloting new support interventions. More recently these have included Training to be an Amputee, Amputee Lunch and Learn, Amputee Carer Transitions and Amputee Learning Hub.
5. Growing a robust model of peer support providing a high quality and credible peer support offer. The investment in the Volunteer Visitor programme will realise greater access to peer support for amputees as well as training and development opportunities for our volunteers.
6. Our Support and Connect outreach programme has been developed to support greater access to LA services across the country. The LA’s outreach team represent and support nationwide in England, Wales and Northern Ireland.
## **COMMUNICATIONS**
The Limbless Association has continued to invest in digital communications and marketing and this has been vital in continuing to raise the profile of the charity and its work during the last couple of years. The new LA website continues to receive positive feedback from service users, members and professionals who tell us that our services, support and events are clearly communicated and accessible. There are a wealth of resources including blogs, podcasts, video content and a dedicated sector resource area. The LA now runs a busy programme of events and our Events Calendar is proving a popular page for stakeholders to keep up to date about ‘what’s on’ at the LA. https://limbless-association.org/events-calendar/
**StepForward,** the LA’s quarterly magazine, remains an important communications tool to enable us to engage with a diverse and growing stakeholder base and is unique in the sector.
In terms of sustaining the magazine, this continues to be a concern. It’s a costly publication whereby costs are no longer covered by advertising revenue. The printed version is an important information and marketing tool that has a significant reach – 4000 circulation. While taking it online removes the print costs there are still production costs that constitute 75% of the overall costs. We would also need to consider how we continue to extend our reach to those that aren’t digitally engaged. Thank you to those of you who have contributed to the magazine and we are immensely grateful for your support. Thank you to all StepForward advertisers who in placing their adverts are supporting our beneficiaries to connect with their peers and the sector on a national scale. We are enormously grateful to them all.
## **SUPPORTING EXCELLENCE**
## **Prosthetic and Orthotics Students Awards**
The Limbless Association once again recognised excellence in those at the beginning of their prosthetics careers by sponsoring the awards for two students at the National Centre for Prosthetics and Orthotics at the University of Strathclyde, Glasgow. The charity was delighted to again sponsor student awards in 2023.
## **David Rose, Chair of the LA** :
“The Limbless Association is delighted to offer our support of these excellent students at the university. These young people represent the future of prosthetic and orthotic services to the limb loss community across the UK. It is particularly satisfying to witness such inspiring examples of student excellence at a time when improvements in prosthetic technology are available to the wider patient community and are enabling very effective levels of rehabilitation. However, the best prosthetic equipment can only work when delivered by a team of rehabilitation professionals who understand the unique needs of each amputee. The prosthetist is at the very heart of this process and it’s reassuring to know that such outstanding students are joining the profession.”
## **Roy Bowers, Course Director, BSc (Hons) Prosthetics and Orthotics, University of Strathclyde** :
“On behalf of the National Centre for Prosthetics and Orthotics, I would like to express my sincere thanks to the Limbless Association for the prizes awarded for best performance by a first year student and for best performance by a graduating student. To have their hard work and achievements recognised in this way by an organisation that represents service users is a fantastic motivation for our students, and a boost to their self-confidence is obvious to all of us teaching on the programme.”
## **INCOME GENERATION**
The majority of our income derives from project specific grant funding programmes and corporate sponsorship. We also have some amazing fundraisers from within the limb loss community and beyond. We celebrate each fundraising achievement across our social media platforms and on the charity’s fundraising webpages and we’re hugely grateful to them all. From organising Afternoon Teas for Amputees to taking part in sponsored challenge
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**Limbless Association**
## **Trustees’ Report**
events, the LA community is ready to get involved and support. However, to sustain and grow our services to meet the need of more amputees we need your support and there are so many ways you can do this; regular giving, leaving a gift in your will, taking on a sponsored challenge. We’d love to hear from you so please get in touch - fundraisingandcommunications@limbless association.org Thank you!
## **OUR FUNDERS**
We are enormously grateful to those funders and Trusts who’ve supported our work during this period. The grant funding landscape is an increasingly challenging one. At the time of writing, grant funding opportunities are diminishing with several key funders pausing programmes while they review their criteria and deal with the backlog of applications they’ve been inundated with. Therefore, we feel privileged to have been supported by the following and thank you to them all.
**National Lottery Reaching Communities National Lottery Awards for All – England, Wales and Northern Ireland Julia Rausing Trust Postcode Places Trust Essex Community Foundation (Health Inequalities Fund) Essex Community Carers Fund (ECC)**
**OUR CORPORATE SUPPORTERS Anthony Gold Solicitors LLP Bolt Burdon Kemp LLP Fieldfisher Stephensons Solicitors LLP Judkins Solicitors Slater and Gordon LLP Enable Law Hudgell Solicitors Hugh James Stewarts Law Hodge Jones & Allen RWK Goodman LLP Evelyn Partners Ottobock Cleveland Clinic Dorset Orthopaedic**
## **Financial review and aims 2023/2024**
The financial landscape for charities, businesses and individuals presented ongoing challenges throughout this period. The impact of the cost of living continued to negatively impact in respect of rising costs for the charity as well as the charity’s ability to attract donor support particularly from individual supporters. The charity had increased investment in its fundraising and marketing activities post the pandemic period (from summer 2021) but this investment has been slow to realise the anticipated return. However, an increase in income was realised during 2023/24 and this is a trajectory that has continued in the current financial period. Community and traditional donor fundraising remains a challenge and we have now recruited an Engagement Manager whose focus is on increasing supporter engagement and nurturing donor relationships. It’s anticipated that this role will lead on the growth of individual and community giving.
The majority of the charity’s income derives from grant making trusts (GMTs) and corporate sponsorship. We have continued to attract GMT funding however, on the whole these are time limited (usually one year) project specific funds. Such funding awards come with funder obligations. Charity resource has to be committed to delivering these projects according to the respective agreed activities and outcomes. This is an increasingly competitive market and due to the widely reported increase in applications the success rates are reducing. Additionally, there are less opportunities available as funders find themselves inundated with applications and are pausing programmes or reviewing their criteria. We are extremely grateful to those funders who’ve supported our work during this period. During 2024/25 we have realised some new opportunities and are excited about the new projects we’re able to deliver as a result.
Page 19
## **Limbless Association**
## **Trustees’ Report**
Corporate sponsorship in the main comes from the LA’s Limb Loss Legal Panel. The firms that form the panel enable the charity to offer expert advice and support to the charity’s service users and members. As well as supporting with potential legal claims, the panel also offer support across a range of topic and activities. These include presenting at the LA’s online and in person thematic events, sponsoring and hosting events as well as supporting with fundraising and volunteering. Their involvement across the charity’s remit is invaluable. At the beginning of the LA’s new financial year the panel have all agreed to provide increased sponsorship levels in 2024/25.
The charity had been the fortunate during the pandemic period to realise bequeathed legacy gifts of significant value. This considerably raised our reserves levels to well beyond our set reserves policy. The Trustees agreed that these reserves would be committed to the LA’s advice and information function and ongoing development of outreach services. However, in 2022/23 legacy incomed of just £3,379 was realised and during the period 2023/24 the charity was in receipt of no legacy income or notifications. The charity’s historical data denotes this as atypical. At the time of writing the charity has received 2 legacy notifications with an estimated value of £180K that we anticipate realising (or a proportion thereof) during 2024/25 or at the latest in the first half of the financial period 2025/26. Unrestricted legacy income provides the charity with free reserves funding to allocate to its services and projects to sustain, develop and where at all possible grow.
There have been increased demands on our services especially at the point of discharge, for amputees and their families and the LA is committed to the development of current services and to optimising opportunities for growth. However, income generation was and has continued to be a key challenge during this current period. The LA board and leadership team work closely to balance the needs of the organisation’s development strategy while monitoring the prevailing risks. Income and expenditure is monitored on an ongoing basis. The need for LA support and services is never more needed and while we’ve increased our capacity to deliver we know that we must to do more to ensure we’re able to reach all those who need our support.
2023/2024 the LA’s financial robustness has presented the greatest risk for the charity. We have worked hard to mitigate that risk and ensure we operate within our reserves policy. At the time of writing, monthly expenditure has been reduced significantly with the measures taken early in 2024 having taken effect from March 2024. This has been achieved through the non-replacement of staff who have left the team and a suspension of the LA’s StepForward magazine due to the increasingly significant costs. The charity is currently exploring alternative options and income generation opportunities to support the magazine’s continuation. StepForward is a publication that is unique in this sector and is valued by LA members and professionals.
At a time in the LA’s history when it has never delivered so much to so many, it has been disappointing for these achievements and investments not to have realised the return we’d hoped for. While reporting an operating deficit for the period 2023/24 the Trustees have utilised the charity’s previously high reserves levels to support continued service developments. As we progress through the 2024/25 period we are optimistic of sharing an improved financial position in our next report.
## **Reserves Policy**
The Trustees have considered the minimum level of reserve that the Charity ought to hold. Reserves (restricted and unrestricted) are needed to bridge the funding gaps between spending and receiving income. While the country has moved forward beyond the pandemic, new challenges are now prevailing. The impact of the pandemic and an ever-growing cost of living crisis are contributing to an increasingly challenging fundraising environment. The Board has examined the requirement for reserves i.e. those funds not invested in tangible fixed assets or otherwise committed. Reserve policy is in place whereby the funds not committed should be held in reserve and maintained at a level which ensures that Limbless Association’s core activity can continue during a period of unforeseen difficulty. This represents three months’ (13 weeks) expenditure of £36,000. The Trustee are aware that as at 31 March 2024, this policy was not met, however as at the time of signing this report the reserve policy requirement is met. This policy will be reviewed annually.
Page 20
**Limbless Association**
## **Trustees’ Report**
## **CHARITABLE OBJECTIVES**
Our key objectives are principally as follows:
- Represent, engage and influence at local and national levels, challenging government and devolved assemblies for the betterment of the limb loss community.
- To increase membership, volunteer and supporter numbers nationwide, increasing and improving our reach to those in need of our services.
- To develop our current services to achieve optimum impact, identifying gaps in early intervention provision where the LA can deploy its experience and expertise to develop projects to further support new amputees and its members.
- To raise the Limbless Association’s profile as a major champion of the limb loss community across a wide range of stakeholders, existing and new.
- To work collaboratively with other charities and agencies to optimise support and reach, maximising a collective voice within the UK.
- To develop strong and mutually productive relationships with professionals and specialists working in all key areas of medical care, recognising and promoting excellence. This includes supporting (non-financial) research projects we determine as important in evidencing the unmet needs of the limb loss community and have an outcomes focus.
- To prove, improve and account for all areas of our service provision ensuring that we are delivering excellent value to our service users and stakeholders alike and realising outcomes set by our funders and by ourselves.
- To develop, plan and implement an ambitious and diverse income generation strategy that supports the charity’s sustainability.
In formulating its objectives, the charity has given due consideration to the Charity Commission’s published guidance on the operation of charities for the public benefit.
## **Statement of trustees' responsibilities**
The trustees (who are also the directors of Limbless Association for the purposes of company law) are responsible for preparing the Trustees' Report and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice), including FRS 102 "The Financial Reporting Standard applicable in the UK and Republic of Ireland".
Company law requires the trustees to prepare financial statements for each financial year. Under company law the trustees must not approve the financial statements unless they are satisfied that they give a true and fair view of the state of affairs of the charitable company and of the incoming resources and application of resources, including its income and expenditure, of the charitable company for that period. In preparing these financial statements, the trustees are required to:
- select suitable accounting policies and apply them consistently;
- observe the methods and principles in the Charities SORP;
- make judgements and estimates that are reasonable and prudent;
- state whether applicable accounting standards, comprising FRS 102 have been followed, subject to any material departures disclosed and explained in the financial statements; and
- prepare the financial statements on the going concern basis unless it is inappropriate to presume that the charitable company will continue in business.
The trustees are responsible for keeping proper accounting records that can disclose with reasonable accuracy at any time the financial position of the charitable company and enable them to ensure that the financial statements comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the charitable company and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.
The trustees are responsible for the maintenance and integrity of the corporate and financial information included on the charitable company's website. Legislation governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions.
Page 21
## **Limbless Association**
## **Trustees’ Report**
## **Compliance with prevailing laws and regulations**
The financial statements have been prepared in accordance with the accounting policies set out in notes to the accounts and comply with the charity’s governing document, the Charities Act 2011 and Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland published on 16 July 2014.
## **Small companies provision statement**
This report has been prepared in accordance with the small companies regime under the Companies Act 2006.
The annual report was approved by the trustees of the charitable company on .............................. and signed on 19 December 2024 their behalf by:
## David Rose
......................................... Mr D M Rose Chairman and Trustee
Page 22
## **Limbless Association**
## **Independent Examiner's Report to the trustees of Limbless Association ('the Company')**
I report to the charitable company trustees on my examination of the accounts of the company for the year ended 31 March 2024 which are set out on pages 24 to 39.
## **Responsibilities and basis of report**
As the charity trustees of the company (and also its directors for the purposes of company law) you are responsible for the preparation of the accounts in accordance with the requirements of the Companies Act 2006 (‘the 2006 Act’).
Having satisfied myself that the accounts of the company are not required to be audited under Part 16 of the 2006 Act and are eligible for independent examination, I report in respect of my examination of your company's accounts as carried out under section 145 of the Charities Act 2011 (‘the 2011 Act’). In carrying out my examination I have followed the Directions given by the Charity Commission under section 145(5)(b) of the 2011 Act.
## **Independent examiner’s statement**
I have completed my examination. I confirm that no matters have come to my attention in connection with the examination giving me cause to believe:
1. accounting records were not kept in respect of the Company as required by section 386 of the 2006 Act; or
2. the accounts do not accord with those records; or
3. the accounts do not comply with the accounting requirements of section 396 of the 2006 Act other than any requirement that the accounts give a ‘true and fair view' which is not a matter considered as part of an independent examination; or
4. the accounts have not been prepared in accordance with the methods and principles of the Statement of Recommended Practice for accounting and reporting by charities applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102).
I have no concerns and have come across no other matters in connection with the examination to which attention should be drawn in this report in order to enable a proper understanding of the accounts to be reached.
...................................... Alex Stone FCCA 146 New London Road Chelmsford Essex CM2 0AW
Date:............................. 19 December 2024
Page 23
## **Limbless Association**
## **Statement of Financial Activities for the Year Ended 31 March 2024 (Including Income and Expenditure Account and Other Comprehensive Income)**
|**Note**
**Income and Endowments from:**
Donations and legacies
3
Other trading activities
4
Investment income
5
Total income
**Expenditure on:**
Raising funds
6
Charitable activities
7
Total expenditure
Gains/losses on investment
assets
Net expenditure
Transfers between funds
Net movement in funds
**Reconciliation of funds**
Total funds brought forward
Total funds carried forward
16|**Unrestricted**
**£**
20,106
101,798
3,332
125,236
82,020
82,997
165,017
76
(39,705)
(119,966)
(159,671)
170,968
11,297|**Restricted**
**£**
118,367
-
-
118,367
-
260,193
260,193
-
(141,826)
119,966
(21,860)
124,795
102,935|**Total**
**2024**
**£**
138,473
101,798
3,332
243,603
82,020
343,190
425,210
76
(181,531)
-
(181,531)
295,763
114,232|**Total**
**2023**
**£**
112,931
75,744
4,959|
|---|---|---|---|---|
|||||193,634|
|||||78,320
405,478|
|||||483,798
(6,096)|
|||||(296,260)
-|
|||||(296,260)
592,023|
|||||295,763|
All of the charitable company's activities derive from continuing operations during the above two periods.
Page 24
## **Limbless Association**
## **(Registration number: 02487661) Balance Sheet as at 31 March 2024**
|||**2024**|**2023**|
|---|---|---|---|
||**Note**|**£**|**£**|
|**Fixed assets**||||
|Tangible assets|11|8,497|14,771|
|Investments|12|80,397|142,945|
|||88,894|157,716|
|**Current assets**||||
|Debtors|13|37,596|47,800|
|Cash at bank and in hand||18,015|119,177|
|||55,611|166,977|
|**Creditors: Amounts falling due within one year**|14|(30,273)|(28,930)|
|**Net current assets**||25,338|138,047|
|**Net assets**||114,232|295,763|
|**Funds of the charitable company:**||||
|**Restricted income funds**||||
|Restricted funds|16|102,935|124,796|
|**Unrestricted income funds**||||
|Unrestricted funds||11,297|170,967|
|**Total funds**|16|114,232|295,763|
For the financial year ending 31 March 2024 the charitable company was entitled to exemption from audit under section 477 of the Companies Act 2006 relating to small companies.
Directors' responsibilities:
- The members have not required the charitable company to obtain an audit of its accounts for the year in question in accordance with section 476; and
- The directors acknowledge their responsibilities for complying with the requirements of the Act with respect to accounting records and the preparation of accounts.
These financial statements have been prepared in accordance with the special provisions relating to companies subject to the small companies regime within Part 15 of the Companies Act 2006.
The financial statements on pages 24 to 39 were approved by the trustees, and authorised for issue on .................................. and signed on their behalf by: 19 December 2024
......................................... Mr D M Rose Chairman and Trustee
Page 25
## **Limbless Association**
## **Notes to the Financial Statements for the Year Ended 31 March 2024**
## **1 Charitable company status**
The charitable company is limited by guarantee, incorporated in England and Wales, and consequently does not have share capital. Each of the trustees is liable to contribute an amount not exceeding £1 towards the assets of the charitable company in the event of liquidation.
## **2 Accounting policies**
## **Summary of significant accounting policies and key accounting estimates**
The principal accounting policies applied in the preparation of these financial statements are set out below. These policies have been consistently applied to all the years presented, unless otherwise stated.
## **Statement of compliance**
The financial statements have been prepared in accordance with Accounting and Reporting by Charities: Statement of Recommended Practice (applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102)) (issued in October 2019) - (Charities SORP (FRS 102)), the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) and the Companies Act 2006.
## **Basis of preparation**
Limbless Association meets the definition of a public benefit entity under FRS 102. Assets and liabilities are initially recognised at historical cost or transaction value unless otherwise stated in the relevant accounting policy notes.
## **Going concern**
The trustees consider that there are no material uncertainties about the charitable company's ability to continue as a going concern nor any significant areas of uncertainty that affect the carrying value of assets held by the charitable company.
## **Income and endowments**
All income is recognised once the charitable company has entitlement to the income, it is probable that the income will be received and the amount of the income receivable can be measured reliably.
## _**Donations and legacies**_
Donations are recognised when the charitable company has been notified in writing of both the amount and settlement date. In the event that a donation is subject to conditions that require a level of performance by the charitable company before the charitable company is entitled to the funds, the income is deferred and not recognised until either those conditions are fully met, or the fulfilment of those conditions is wholly within the control of the charitable company and it is probable that these conditions will be fulfilled in the reporting period.
Legacy gifts are recognised on a case by case basis following the grant of probate when the administrator/executor for the estate has communicated in writing both the amount and settlement date. In the event that the gift is in the form of an asset other than cash or a financial asset traded on a recognised stock exchange, recognition is subject to the value of the gift being reliably measurable with a degree of reasonable accuracy and the title to the asset having been transferred to the charitable company.
Page 26
## **Limbless Association**
## **Notes to the Financial Statements for the Year Ended 31 March 2024**
## _**Grants receivable**_
Grants are recognised when the charitable company has an entitlement to the funds and any conditions linked to the grants have been met. Where performance conditions are attached to the grant and are yet to be met, the income is recognised as a liability and included on the balance sheet as deferred income to be released.
## _**Deferred income**_
Deferred income represents amounts received for future periods and is released to incoming resources in the period for which, it has been received. Such income is only deferred when:
- The donor specifies that the grant or donation must only be used in future accounting periods; or - The donor has imposed conditions which must be met before the charitable company has unconditional entitlement.
## _**Investment income**_
Dividends are recognised once the dividend has been declared and notification has been received of the dividend due.
## **Expenditure**
All expenditure is recognised once there is a legal or constructive obligation to that expenditure, it is probable settlement is required and the amount can be measured reliably. All costs are allocated to the applicable expenditure heading that aggregate similar costs to that category. Where costs cannot be directly attributed to particular headings they have been allocated on a basis consistent with the use of resources, with central staff costs allocated on the basis of time spent, and depreciation charges allocated on the portion of the asset’s use. Other support costs are allocated based on the spread of staff costs.
## _**Raising funds**_
These are costs incurred in attracting voluntary income, the management of investments and those incurred in trading activities that raise funds.
## _**Charitable activities**_
Charitable expenditure comprises those costs incurred by the charitable company in the delivery of its activities and services for its beneficiaries. It includes both costs that can be allocated directly to such activities and those costs of an indirect nature necessary to support them.
## **Governance costs**
These include the costs attributable to the charitable company’s compliance with constitutional and statutory requirements, including audit, strategic management and trustees meetings and reimbursed expenses.
## **Taxation**
The charitable company is considered to pass the tests set out in Paragraph 1 Schedule 6 of the Finance Act 2010 and therefore it meets the definition of a charitable company for UK corporation tax purposes. Accordingly, the charitable company is potentially exempt from taxation in respect of income or capital gains received within categories covered by Chapter 3 Part 11 of the Corporation Tax Act 2010 or Section 256 of the Taxation of Chargeable Gains Act 1992, to the extent that such income or gains are applied exclusively to charitable purposes.
Page 27
## **Limbless Association**
## **Notes to the Financial Statements for the Year Ended 31 March 2024**
## **Tangible fixed assets**
Individual fixed assets are initially recorded at cost, less any subsequent accumulated depreciation and subsequent accumulated impairment losses.
## **Depreciation and amortisation**
Depreciation is provided on tangible fixed assets so as to write off the cost or valuation, less any estimated residual value, over their expected useful economic life as follows:
**Asset class** Fixtures and fittings Computer equipment
**Depreciation method and rate** 20% to 33% straight line 33% straight line
## **Fixed asset investments**
Fixed asset investments, other than programme related investments, are included at market value at the balance sheet date. Realised gains and losses on investments are calculated as the difference between sales proceeds and their market value at the start of the year, or their subsequent cost, and are charged or credited to the Statement of Financial Activities in the period of disposal.
Unrealised gains and losses represent the movement in market values during the year and are credited or charged to the Statement of Financial Activities based on the market value at the year end.
## **Trade debtors**
Trade debtors are amounts due from customers for merchandise sold or services performed in the ordinary course of business.
Trade debtors are recognised initially at the transaction price. They are subsequently measured at amortised cost using the effective interest method, less provision for impairment. A provision for the impairment of trade debtors is established when there is objective evidence that the charitable company will not be able to collect all amounts due according to the original terms of the receivables.
## **Cash and cash equivalents**
Cash and cash equivalents comprise cash on hand and call deposits, and other short-term highly liquid investments that are readily convertible to a known amount of cash and are subject to an insignificant risk of change in value.
## **Trade creditors**
Trade creditors are obligations to pay for goods or services that have been acquired in the ordinary course of business from suppliers. Accounts payable are classified as current liabilities if the charitable company does not have an unconditional right, at the end of the reporting period, to defer settlement of the creditor for at least twelve months after the reporting date. If there is an unconditional right to defer settlement for at least twelve months after the reporting date, they are presented as non-current liabilities.
Trade creditors are recognised initially at the transaction price and subsequently measured at amortised cost using the effective interest method.
Page 28
## **Limbless Association**
## **Notes to the Financial Statements for the Year Ended 31 March 2024**
## **Fund structure**
Unrestricted income funds are general funds that are available for use at the trustees's discretion in furtherance of the objectives of the charitable company.
Restricted income funds are those donated for use in a particular area or for specific purposes, the use of which is restricted to that area or purpose.
## **Financial instruments**
## _**Classification**_
Financial assets and financial liabilities are recognised when the charitable company becomes a party to the contractual provisions of the instrument.
Financial liabilities and equity instruments are classified according to the substance of the contractual arrangements entered into. An equity instrument is any contract that evidences a residual interest in the assets of the charitable company after deducting all of its liabilities.
## **3 Income from donations and legacies**
|Donations receivable
Legacies
Grants receivable|**Unrestricted**
**funds**
**£**
20,106
-
-
20,106|**Restricted**
**funds**
**£**
30,000
-
88,367
118,367|**Total**
**2024**
**£**
50,106
-
88,367
138,473|**Total**
**2023**
**£**
23,647
3,379
85,905|
|---|---|---|---|---|
|||||112,931|
Page 29
## **Limbless Association**
## **Notes to the Financial Statements for the Year Ended 31 March 2024**
|**4**
**Income from other trading activities**
**Unrestricted**
**funds**
**£**
Events and other income
56,138
Membership subscriptions
40,292
Direct marketing income
5,368
101,798
**5**
**Investment income**
**Unrestricted**
**funds**
**£**
Interest receivable
720
Other income from fixed asset
investments
2,612
3,332
**6**
**Expenditure on raising funds**
Costs of generating donations and legacies|**Restricted**
**funds**
**£**
-
-
-
-
**Restricted**
**funds**
**£**
-
-
-
**Allocated**
**support costs**
**£**
82,020|**Total**
**2024**
**£**
56,138
40,292
5,368
101,798
**Total**
**2024**
**£**
720
2,612
3,332
**Total**
**2024**
**£**
82,020|**Total**
**2023**
**£**
31,416
40,500
3,828|
|---|---|---|---|
||||75,744|
||||**Total**
**2023**
**£**
396
4,563|
||||4,959|
||||**Total**
**2023**
**£**
78,320|
Page 30
## **Limbless Association**
## **Notes to the Financial Statements for the Year Ended 31 March 2024**
## **7 Expenditure on charitable activities**
|Staff costs
Rent
Direct project costs
Office costs, repairs and
maintenance
Donations
Insurance
Advertising
Marketing and communications
including Step Forward Publication
costs
Travel and subsistence
Telephone
Postage and stationery
Staff training and recruitment
Legal and professional
Depreciation
Bank charges
Governance costs (note 8)|**Activity**
**undertaken**
**directly**
**£**
232,159
-
13,684
-
1,050
-
8,968
13,086
5,816
6,216
1,754
1,636
796
3,599
-
-
288,764|**Activity**
**support costs**
**£**
13,159
-
-
2,758
-
3,586
6,726
-
1,543
7,286
4,281
818
1,195
3,599
845
8,630
54,426|**2024**
**£**
245,318
-
13,684
2,758
1,050
3,586
15,694
13,086
7,359
13,502
6,035
2,454
1,991
7,198
845
8,630
343,190|**2023**
**£**
292,565
1,917
11,647
3,094
1,152
2,225
15,769
11,362
19,197
12,441
6,359
-
4,041
9,562
1,203
12,944|
|---|---|---|---|---|
|||||405,478|
Page 31
## **Limbless Association**
## **Notes to the Financial Statements for the Year Ended 31 March 2024**
## **8 Analysis of governance and support costs**
## **Governance costs**
|Staff costs
Audit and accountancy fees
Trustees remuneration and expenses
Legal and professional fees
Other governance costs|**Total**
**2024**
**£**
-
5,222
486
245
2,677
8,630|**Total**
**2023**
**£**
743
9,120
-
-
3,081|
|---|---|---|
|||12,944|
## **9 Trustees remuneration and expenses**
No trustees, nor any persons connected with them, have received any remuneration from the charitable company during the year.
During the year, 1 trustee was reimbursed for reasonable travel expenses totalling £486 (2023: £1,318 to 1 trustee).
## **10 Staff costs**
The aggregate payroll costs were as follows:
|The aggregate payroll costs were as follows:|||
|---|---|---|
|**Staff costs during the year were:**
Wages and salaries
Social security costs
Pension costs|**2024**
**£**
246,626
10,202
5,478
262,306|**2023**
**£**
296,555
16,389
6,686|
|||319,630|
The monthly average number of persons (including senior management / leadership team) employed by the charitable company during the year expressed by head count was as follows:
|||**2024**||**2023**||
|---|---|---|---|---|---|
|||**No**||**No**||
|Administrative|staff||16||19|
No employee received emoluments of more than £60,000 during the year.
The total employee benefits of the 2 members of staff forming the key management personnel of the charitable company were £74,651 (2023 - £77,320).
Page 32
## **Limbless Association**
## **Notes to the Financial Statements for the Year Ended 31 March 2024**
|**11 Tangible fixed assets**
**Cost**
At 1 April 2023
Additions
At 31 March 2024
**Depreciation**
At 1 April 2023
Charge for the year
At 31 March 2024
**Net book value**
At 31 March 2024
At 31 March 2023|**Furniture and**
**equipment**
**£**
43,221
4,524
47,745
29,726
9,549
39,275
8,470
13,495|**Computer**
**equipment**
**£**
17,274
-
17,274
15,998
1,249
17,247
27
1,276|**Total**
**£**
60,495
4,524|
|---|---|---|---|
||||65,019|
||||45,724
10,798|
||||56,522|
||||8,497|
||||14,771|
Page 33
## **Limbless Association**
## **Notes to the Financial Statements for the Year Ended 31 March 2024**
## **12 Fixed asset investments**
## **Other investments**
|**Other investments**|||||
|---|---|---|---|---|
|**Cost or Valuation**
At 1 April 2023
Revaluation
Disposals
At 31 March 2024
**Net book value**
At 31 March 2024
At 31 March 2023
**13 Debtors**
Trade debtors
Prepayments
Accrued income
**14 Creditors: amounts falling due within one year**
Trade creditors
Other taxation and social security
Other creditors
Accruals
Deferred income||**Unlisted**
**investments**
**£**
142,945
76
(62,624)
80,397
80,397
142,945
**2024**
**£**
23,586
-
14,010
37,596
**2024**
**£**
16,523
-
853
10,980
1,917
30,273||**Total**
**£**
142,945
76
(62,624)
80,397
80,397
142,945
**2023**
**£**
32,040
5,760
10,000|
|||80,397|||
|||80,397|||
|||142,945|||
|||**2024**
**£**
23,586
-
14,010
37,596
**2024**
**£**
16,523
-
853
10,980
1,917
30,273|||
|||||47,800|
|||||**2023**
**£**
7,822
2,978
2,030
12,100
4,000|
|||||28,930|
Page 34
## **Limbless Association**
## **Notes to the Financial Statements for the Year Ended 31 March 2024**
|Deferred income at 1 April 2023
Resources deferred in the period
Amounts released from previous periods
Deferred income at year end|**2024**
**£**
4,000
1,917
(4,000)
1,917|**2023**
**£**
4,000
4,000
(4,000)|
|---|---|---|
|||4,000|
The charity has received income from a number of benefactors who have stipulated that the funds are provided on the condition that they are used over a specific period of time.
Grants and donations received which have these conditions attached are held as deferred income until the charity has met the criteria, at which point it is then entitled to recognise this money as income received in the statement of financial activity (SOFA).
## **15 Obligations under leases and hire purchase contracts**
## **Operating lease commitments**
Total future minimum lease payments under non-cancellable operating leases are as follows:
|**Other**
Within one year
Between one and five years|**2024**
**£**
550
802
1,352|**2023**
**£**
550
1,352|
|---|---|---|
|||1,902|
Page 35
## **Limbless Association**
## **Notes to the Financial Statements for the Year Ended 31 March 2024**
## **16 Funds**
_**Current year:**_
|**Balance at 1**
**April 2023**
**£**
**Unrestricted funds**
General fund
170,967
**Restricted**
Support and Connect
Glasgow
9,581
Training to be Amputee
-
Iraqi Project
61,103
Amputee Carer Transitions
-
Amputee Learning Hub
-
Support and Connect
Outreach Project
10,291
Peer Support Project
43,821
**Total restricted**
124,796
**Total funds**
295,763
**_Prior year:_**
**Balance**
**at 1 April**
**2022**
**£**
**Unrestricted funds**
General fund
366,960
**Restricted**
Support and Connect
Glasgow
9,581
Support Connect Hub Project
-
Iraqi Project
105,576
Support and Connect
Outreach Project
9,281
Peer Support Project
100,625
**Total restricted funds**
225,063
**Total funds**
592,023|**Incoming**
**resources**
**£**
125,234
-
34,897
-
14,010
19,860
19,600
30,000
118,367
243,601
**Incoming**
**resources**
**£**
99,529
-
93,095
-
1,010
-
94,105
193,634|**Resources**
**expended**
**£**
(165,014)
-
(18,703)
(19,856)
-
(6,535)
(149,857)
(65,243)
(260,194)
(425,208)
**Resources**
**expended**
**£**
(170,426)
-
(212,095)
(44,473)
-
(56,804)
(313,372)
(483,798)|**Transfers**
**£**
**Other**
**recognised**
**gains/(losses)**
**£**
(119,966)
76
-
-
-
-
-
-
-
-
-
-
119,966
-
-
-
119,966
-
-
76
**Transfers**
**£**
**Other**
**recognised**
**gains/(losses)**
**£**
(119,000)
(6,096)
-
-
119,000
-
-
-
-
-
-
-
119,000
-
-
(6,096)|**Balance**
**at 31**
**March**
**2024**
**£**
11,297
9,581
16,194
41,247
14,010
13,325
-
8,578|
|---|---|---|---|---|
|||||102,935|
|||||114,232|
|||||**Balance**
**at 31**
**March**
**2023**
**£**
170,967
9,581
-
61,103
10,291
43,821|
|||||124,796|
|||||295,763|
Page 36
**Notes to the Financial Statements for the Year Ended 31 March 2024**
## **Limbless Association**
The specific purposes for which the funds are to be applied are as follows:
## Support and Connect Glasgow Fund
To support a range of projects that will be developed for the benefit of patients and their families attending the West of Scotland Mobility and Rehabilitation Centre, Glasgow.
## Support Connect Hub Project
To provide amputees with a group peer networking opportunity where they can meet with others, to share their experiences and improve their rehabilitation and recovery. The Hub project offers monthly informal drop-ins for information, support and connectivity. The Hub project key aims are to reduce the isolation that amputees experience, improve amputees' knowledge regarding recovery and life after limb loss and introduce amputees to activities and other experiences to improve their well-being and quality of life.
## Training to be Amputee Project (place-based in Essex)
An LA Amputee Learning Hub initiative. To develop and deliver a local bespoke learning programme for amputees and their families which helps to empower and support amputees who may be struggling. The programme addresses key topics relevant to those within the early days of their limb loss (and at pre-amputation) with the aim of educating and empowering their rehabilitation pathway and tackling health inequalities for many who are experiencing limb loss.
## Legacy - Iraqi Support and Inclusion Project
This legacy gift is restricted to 'supporting Iraqi amputees, where at all possible'. The LA will initially aim to ensure that it's services are fully accessible to Iraqi amputees and their families living in the UK, including peer support. We will aim to engage with and learn about this community to understand and scope its specific challenges with a view to determining further support and strategies according to the need identified and aligning with LA objects.
## Amputee Carer Transitions
Amputee Carer Transitions (ACT) is a programme dedicated to addressing and meeting the needs of amputee carers. Increasing visibility of this group, improving access to information, support, peer networking and development opportunities. Leading to amputee carers being more informed and more resilient to support their loved ones in their (life) long and challenging rehabilitation.
## Amputee Learning Hub
To develop and deliver a national programme of learning for amputees and their families. Peer led activities will be delivered online and in person aiming to improve knowledge of the rehabilitation pathway and address health inequalities. Activities will include the LA’s Virtually Speaking thematic sessions and regional Lunch and Learn events.
## Support and Connect Outreach Project
To expand Limbless Association outreach support in NI. To develop a Northern Ireland outreach programme based on the model already established in England and Wales and raise awareness of the charity providing amputees and their families with improved access to LA services. A dedicated Outreach Coordinator based in NI has been recruited.
## Peer Support Project
The LA's Volunteer Visitor network offers peer mentoring and support to individuals and their families. LA Volunteer Visitors are experienced amputees (of two or more years) who offer to support more recent amputees and those pre-amputation. This national peer-to-peer support provides recent amputees with practical advice and information relating to limb loss from someone with lived experience who can understand the difficulties they are facing.
Page 37
## **Limbless Association**
## **Notes to the Financial Statements for the Year Ended 31 March 2024**
## Transfers between funds
The transfer of funds of £119,966 to the Support Connect Hub Ireland is a decision made by the trustees to fund its activities from unrestricted reserves.
## **17 Analysis of net assets between funds**
|Tangible fixed assets
Fixed asset investments
Current assets
Current liabilities
Total net assets
Tangible fixed assets
Fixed asset investments
Current assets
Current liabilities
Total net assets|**Unrestricted**
**funds**
**£**
8,470
13,837
19,263
(30,273)
11,297
**Unrestricted**
**funds**
**£**
13,495
142,945
43,457
(28,930)
170,967|**Restricted**
**funds**
**£**
27
66,560
36,348
-
102,935
**Restricted**
**funds**
**£**
1,276
-
123,520
-
124,796|**Total funds at**
**31 March**
**2024**
**£**
8,497
80,397
55,611
(30,273)|
|---|---|---|---|
||||114,232|
||||**Total funds at**
**31 March**
**2023**
**£**
14,771
142,945
166,977
(28,930)|
||||295,763|
## **18 Related party transactions**
During the year the charitable company made the following related party transactions:
## **Judkins Solicitors**
(One of the trustees is the owner)
During the year, legal panel donations of £3,983 (2023: £5,000) were received. At the balance sheet date the amount due from Judkins Solicitors was £9,833 (2023 - £15,000).
Page 38
## **Limbless Association**
## **Notes to the Financial Statements for the Year Ended 31 March 2024**
## **19 Prior year Statement of Financial Activities**
|**Note**
**Income and Endowments from:**
Donations and legacies
3
Other trading activities
4
Investment income
5
Total income
**Expenditure on:**
Raising funds
6
Charitable activities
7
Total expenditure
Gains/losses on investment assets
Net expenditure
Transfers between funds
Net movement in funds
**Reconciliation of funds**
Total funds brought forward
Total funds carried forward
16|**Unrestricted**
**£**
18,826
75,744
4,959
99,529
78,320
92,106
170,426
(6,096)
(76,993)
(119,000)
(195,993)
366,960
170,967|**Restricted**
**£**
94,105
-
-
94,105
-
313,372
313,372
-
(219,267)
119,000
(100,267)
225,063
124,796|**Total**
**2023**
**£**
112,931
75,744
4,959|
|---|---|---|---|
||||193,634|
||||78,320
405,478|
||||483,798
(6,096)|
||||(296,260)
-|
||||(296,260)
592,023|
||||295,763|
Page 39