TRAUMA & ORTHOPAEDICS RESEARCH CHARITY TRUSTEES. REPORT (INCLUDING DIRECTORS. REPORT) FOR THE YEAR ENDED 31 MARCH 2023 The Trustees present their annual report and financial statements ft)r the year ended 31 March 2023. The financial statements have been prepared in accordance with the accounting policies set out in note 1 to the financial statements and comply with the charity's goveming do¢ument, the Companies Act 2006 and "Accounting and Reporting by Charities- Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102)" {effe¢tive 1 January 2019). The Annual Report setves the purposes of both a Trustees. report and a directors, report under company law. Objectives and activities a. Policies and objectives The principle activity of the charity is to continually improve the provision of holistic care for all those with musculoskeletal injury or disease in Northern Ireland. b. Activities undertaken to achieve objectives The Trustees are pleased to report that the charity continues to improve the provision of holistic care for all those with musculoskeletal injury or disease in Northern Ireland. c. Main activities undertaken to further the company's purposes for the public benefit The charity has a number of different projects running, the results of the major ones are listed below in the Main achievements and Review of activities of the company. Achievements and performance Fundraising While we had hoped 2022 would see a retum for our annual Walk in June, we were unable to get new staff in place in time to hold it. The following table and chart summarises fundraising. Fundraising & Donation Figures (only) Christmas Newsletter 2022 Balmoral Golf Event Food Nl Awards 2023 Tesco Bag Pack Wallace School Ringdufferin Nursing Home Bake Sale Gift In Will General Donations Total {£) 4,002.50 £5,555.30 £620.00 £704.50 £138.93 £270.00 £9,342.50 £20,633.73 27% 30 45° TRAUMA & ORTHOPAEDICS RESEARCH CHARITY TRUSTEES. REPORT (INCLUDING DIRECTORS, REPORT) (CONTINUED) FOR THE YEAR ENDED 31 MARCH 2023 ChfL2rn)sN¥w4sletier 1022 88rncT?IGoYEvthL F￿1 NE AwBrd5 2023 •TVAO8agP￿tWa4*￿tkh¢>3l 27% Rngdtrtuin NwsirE Hcme We sae Gft In'KJll • GewalOcfoTL Patient Liaison Group The Patient Liaison Group had its first meeting Sin￿ COVID in 2022. Research The following clinical trials were taking place- WAX- Weight-bearing in Ankle Fractures (University of Oxford). This finished in October. SCIENCE - Surgery or Cast for Injuries of the Epicondyle in Children's Elbows (University of Oxford) Study of Retrieved Orthopaedic Implants and Associated Tissues and Data (University of Leeds) BASIS - Bracing Adolescent Idiopathic Scoliosis (Sheffield Children's NHS Foundation Trust) The effect of strontium on mesenchymal stem cells from osteoporotic donors (Queen's University Belfast) HUSH - The Humeral Shaft fracture trial {University of Oxford) The safety of cementless total knee arthroplasty in osteoporoti¢ bone (Belfast Trust) The following audits were completed.. 90 day complications in elective arthroplasty in Musgrave Park Hospital (ongoing since 2016) Outcomes after rib fixation for acute Chest trauma Functional outGome and risk of non-union for 5th metatarsal base fractures Blood loss in fractured neck of femur patients Functional outcomes of patella fractures following operative intervention Operative Management of displa¢ed 3 and 4-part fractures of the proximal humerus Factors influencing hip fracture mortality in a unit with high orthogeriatric input Survivorship of Corail and Exeter stems in total hip arthroplasty Survivorship of 500 Cementless total knee arthroplasties in patients under 55 Time for a new DVT assessment protocol following lower limb arthroplasty? Is morbid obesity associated with increased risk of venous thromboembolism following lower limb arthroplasty? 90 day ¢ompli¢ations of waiting list initiative primary joint patients in N.1. Waiting for hip and knee arthroplasty in N. l. - the painful truth. TRAUMA & ORTHOPAEDICS RESEARCH CHARITY TRUSTEES. REPORT (INCLUDING DIRECTORS. REPORT) (CONTINUED) FOR THE YEAR ENDED 31 MARCH 2023 In addition, approval was being sought to start the following clinical trials.. Can the use of Virtual Reality Improve Outcomes Following Total Knee Arthroplasty with Spinal Anaesthesia (Belfast Trust) G-FORCE - Gait in Fixed Or Rotating Cementless Total Knee Arthroplasties (Belfast Trust) A Randomised Controlled Trial of Tourniquet Use in Ankle Fracture Surgery (Belfast trust) METEOR-2: The Meniscal Transplant surgery or Optimised Rehabilitation full randomised trial (University of Warwick) WHITE (LIT) World Hip Trauma Evaluation 10.. Lidocaine Intravenous Trial (University of Oxford) WHITE (DUALITY): World Hip Trauma Evaluation 12, Dual mobility versus standard articulation total hip replacement in the treatment of older adults with a hip fracture (University of Oxford) RAPSODI.. Reverse or Anatomical replacement for Painful Shoulder Osteoarthritis. Differences between Interventions.. a multi-centre, pragmatic, parallel group, superiority randomised controlled trial (University of York) The research team were involved in the following publications.. 1. Is Cementless Total Knee Arthroplasty Safe in Women Over 75 Y of Age? Gibbons JP, Cassidy RS, Bryce L, Napier RJ, Bloch BV, Beverland DE. J Arthroplasty. 2022 O¢t 19.'S0883-5403{22)00958-5. Online ahead of print. 2. Survivorship of 500 Cementless Total Knee Arthroplasties in Patients under 55 Years of Age. Sheridan GA, Cassidy RS, McKee C, Hughes I, Hill JC, Beverland DE. J Arthroplasty. 2022 Oct 26:S0883-5403(22)00972-X. Online ahead of print. 3. The Influence of Orthopedic Surgery on Circulating Metabolite Levels, and their Associations with the Incidence of Postoperative Delirium. Jung M, Pan X, Cunningham EL, Passmore AP, M¢Guinness B, McAuley DF, Beverland D, O'Brien S, Mawhinney T, Schott JM, Zetterberg H, Green BD. Metabolites. 2022 Jul 1,'12(7):616. 4. Using tranexamic acid for an additional 24 hours postoperatively in hip and knee arthroplasty saves money.. a cost analysis from the TRAC-24 randomized control trial. Karayiannis PN, Agus A, Bryce L, Hill JC, Beverland D. Bone Jt Open. 2022 Jul,'3<7).'536-542. 5. Factors influencing resilience to postoperative delirium in adults undergoing elective orthopaedic surgery. Bowman EML, Cardwell C, McAuley DF, McGuinness B, Passmore AP, Beverland D, Zetterberg H, Schott JM, Cunningham EL. Br J Surg. 2022 Sep 9',109{10).'908-911. 6. Cup pla¢ement in primary total hip arthroplasty: how to get it right without navigation or robotics. Meermans G, Grammatopoulos G, Innmann M, Beverland D. EFORT Open Rev. 2022 May 31,'7(61.'365-374. 7. Mid-term results of the treatment of complex acetabular fractures with combined acute fixation and total hip replacement in the older patient. Bassett JW, Diamond OJ, Spence DJ, Ward AJ, Acharya MR, Chesser TJS. Hip Int. 2022 Dec 21'.11207000221145437. Online ahead of print. Education TORC has contributed to the following.. Leeann Bryce. research nurse, graduated in her nursing degree at Queen's University Belfast in July 2022. Roslyn Cassidy, TORC data analyst, completed her course on Statistical Methods in Epidemiology remotely with the University of London, finishing in June 2022. TORC hosted a Trauma Simulation Training for T&0 trainees in December. The training took place at the Intersim Centre in Queen's University Belfast. The production and funding of new patient education booklets for major trauma patients in the Belfast Trust called 'Steps to Recovery Following Traumatic Injury., TRAUMA & ORTHOPAEDICS RESEARCH CHARITY TRUSTEES. REPORT (INCLUDING DIRECTORS, REPORT) {CONTINUED) FOR THE YEAR ENDED 31 MARCH 2023 Attendance for staff and orthopaedic trainees to attend and present both oral and poster presentatons of TORC research at the following Conferences: 1. Irish Orthopaedic Foot and Ankle Society (IOFA) Scientific Meeting 2. European Federation of National Associations of Orthopaedics and Traumatology (EFORT) Annual Congress 3. British Association for Surgery ofthe Knee (BASK) Conference 4. European Society for Thoracic Surgeons (ESTS) Annual Conference 5. National Institute for Health Research (NIHR) Trauma Trials Annual Meeting 6. Orthopaedic Trauma Society (OTS) Annual Conferen 7. Society for Cardiothoracic Surgery in Great Britain and Ireland Annual Meeting 8. British OrthopaedicAssociation (BOA) Annual Congress 9. European Delirium Association (EDA) Annual Meeting 10. British Hip Society (BHS) annual meeting Support The Multidisciplinary Orthopaedic Training and Simulation room opened in January in Musgrave Park Hospital. The simulator has been well used to date with 21 registered users (16 Trainees & 5 Consultants). 632 Training modules have been completed by all current registered users. This had led to a safer learning environment with trainees completing procedures on the simulator before moving to learning these in theatre meaning it is safer for patients. Consultants have used it to refresh skills and update on new techniques. TORC also co-ordinated a project with local non-profit organisation. Heartship who provide lifesaving medical supplies to countries in war and famine. They required volunteers with experience of surgical instruments to sort £2.5M worth of historical surgical supplies. TORC volunteers helped to categorise these over 6 weeks and it has now been sent to countries like Ukraine that are able to make use of it. Future Plans In the nexi 12 months, the research team will be continuing with the on-going research studies and aiming to get approval for the planned research listed above. With new staff in post, TORC will be focusing on fundraising through.. Improving Digital marketing tools.. Facebook, Instagram, twitter and Linkedln plus fundraising platforms.. Just Giving and Enthuse. We will also look into using Mail Chimp for conta¢ting donors, and Eventbrite for events plus update the website with new fundraising information. Participation in several ￿ndraising events such as an abseil challenge, running events like the Belfast Marathon and TORC run events like the Musgrave Mile and the TORC Walk. New literature about the charity will be designed and printed. Available to download or hand out at health fairs and seminars. TORC is also planning a refurbishment of the existing BART Room to create a training and education hub for staff. It will also have space for training and have video conferencing facilities for meetings plus work stabons to allow trainees to complete research. TRAUMA & ORTHOPAEDICS RESEARCH CHARITY TRUSTEES. REPORT (INCLUDING DIRECTORS. REPORT) {CONTINUED) FOR THE YEAR ENDED 31 MARCH 2023 Financial review After reviewing the Charity's fore¢asts and projections, the Trustees have a reasonable expectation that the charity has adequate resources to continue in operational existence for the foreseeable future. The charity therefore continues to adopt the going concem basis in preparing its financial statements. With salary costs now approximately £230k per year and the refurbishment of the BART Room going to cost approximately £100K. This is a challenging time for the charity and while it is expected that fundraising and donations will increase with the addition of I￿0 new members of staff, it will take time for this to grow, however it is reassuring that the MITRE had agreed in 2019 to an annual sum of £100,000 for 5 years. The trustees will consider on an ongoing basis the level of reseNes that is prudent for the charity to have in line with known future developments, liabilities and uncertainties. The Net Current Assets at 31st March 2023 were £829,014 (2022 £854,454) with restricted funds at £113,486 (2022 - £65.983). designated funds amounting to £338,379 {2022 - £115,220) reflecting an underlying unrestricted funds reserve of £377,149 {2022 £673,251). The designated funds are expected to be utilised over the next 12 to 24 months. Structur8. governanco and management a. Constitution Trauma & Orthopaedics Research Charity is registered as a charitable company limited by guarantee and was set up by a Trust deed. b. Methods of appointment or election of Trustees The management of the company is the responsibility of the Trustees who are elected and Co-opted under the terms of the Trust deed. Organisational structure and decision-making policies The board is responsible for setting the mission, vision, values and strategic objectives of the charity and for overseeing the implementation of those objectives. David Beverland has been delegated day to day management. d. Pay policy for key management personnel Trustees are not remunerated and are appointed based on merit and against objective criteria. Although trustee appointments are not publi¢ appointments, the charity aims to comply with the principles of the Commissioner for Publi¢ Appointments in Northern Ireland (merit, diversity. equality, openness, transparency, independenGe, integrity, proportionality and respect). Financial risk management The Trustees have assessed the major risks to which the company is exposed, in particular those related to the operations and finances of the company. and are satisfied that systems and procedures are in place to mitigate exposure to the major risks. The Trustees, who are also the directors for the purpose of company law, and who served during the year and up to the date of signature of the financial ststements were.. Mr S Curry Mr E McGinley Mr D Molloy Mr P Magill Dr R Hogg Mr R Napier Dr J Mccaffrey Mr O Diamond Mr D Gibson TRAUMA & ORTHOPAEDICS RESEARCH CHARITY TRUSTEES, REPORT (INCLUDING DIRECTORS, REPORT) (CONTINUED) FOR THE YEAR ENDED 31 MARCH 2023 None of the Trustees has any beneficial interesl in the company. All of the Trustee5 are members of the company and guarantee to contribute £1 in the event of a winding up. Appointment of newstaff The year Started wlth no direct charity Staff. Beverley Leckey left the charity on 31st December 2021 and replaclng her proved dlfficult through the Belfas1 Trust so it was agreed new staff would be employed directly through the charity. It was decided to recruit for a full time Band 6 office managerlfundraising co-ordSnator and a part time Band 4 adminlstrator. This would allaw more lime for fundraising which will be needed when Professor Beverland's contributions to the charity stop. Amanda Watson (Band 6) started on the 14th November 2022 and Sandra Wragg (Band 4) on 9th January 2023. Statement of Truste8s' responslbilities The Trustees, who are also the directors ofTrauma & Orthopaedics Research Charity for the purpose 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). Company Law requires the Trustees to Prepare financial statements for each financial year which gwe a true and fair vlew of the state of affairs of the ¢harity and of the incoming resources and applicatlon of resources, Inciuding the income and expenditure, of the charitable company for Ihal year. In preparlng these financial statements, the Truslees are required to.. select sultable accounting policies and then apply them consistently., observe the methods and principles in the Charities SORP: make judgements and estimates that are reasonable and prudent,. and prepare the financial statements on the going concern basis unless il Is Inappropriate to presurne that the charity wlll conlinue In operatlon. The Trustees are responsible for keeping adequate accounting ￿CordS that disclose with reasonable accuracy at any time the financial position of the charity and enable them to ensure that the ff nancial statemen t5 comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the charity and hence for taking reasonable steps for the prevention and detection of fraud and other irregularilles. Audltor In accordance wilh the company'5 article5. a resolution proposing thal Miscampbell & Co be reappointed as auditor of the company will be put at a General Meeling. The Trustees, re ort was approved by the Board of Tru51ees. Mr R Napi Trustee 22 June 2023