Annual Report 2017 BARTS CHARITY
Ground Floor, 12 Cock Lane London EC1A 9BU Tel: 020 7618 1717 Fax: 020 7248 9395 Web: www.bartscharity.org.uk Barts Charity is a charity registered in England and Wales, no. 212563, and a company registered in England and Wales, no. 7168381, whose registered office is 12 Cock Lane, London EC1A 9BU.
ANNUAL REPORT 2017
Barts Charity
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Contents 2
Chairman’s report
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Barts Charity: A year in numbers Our communities
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Our partners: Barts Health Barts and The London School of Medicine and Dentistry
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Our supporters
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Grant stories Impact of our research Transforming patient care Improving lives in the community
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Governance Governance review Trustees and Board Advisers
28 30
Finance Finance review and strategic report
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Financial statements Statement of Trustees’ responsibilities 36 Auditor’s report 37 Financial statements and notes to the accounts 38
bartscharity.org.uk
Annual Report 2016/17
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Chairman’s report
Our partnerships with Barts Health NHS Trust and Barts and The London School of Medicine and Dentistry put Barts Charity in a unique position to help transform healthcare in East London and beyond. The diverse and growing population of East London presents Barts Health NHS Trust (Barts Health) with significant healthcare challenges. In 2016/17, our new CEO, Fiona Miller Smith, and I led a strategic review of the Charity, to consider how we could best respond to these challenges. With the support of Trustees, we committed to increase our annual grant-giving to £30m for at least the next three years. This reflects not only the Charity’s underlying financial strength, but also our confidence in the leadership of both Barts Health and Barts and The London School of Medicine and Dentistry (SMD). By working closely with both institutions, we ensure that our grants will be aligned with their strategic priorities, and we already have an exciting pipeline of potential funding projects for innovative healthcare initiatives and world-leading medical research for
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Annual Report 2016/17
this and the coming years. One of the funding highlights of 2016/17 was the opening of the Rainbow Centre at Newham University Hospital, following a £6.85m Barts Charity grant (see page 18). Not only is the Centre helping Barts Health improve the care it provides to children and young people in Newham, but it also illustrates a key aspect of our grant-giving strategy that we are looking to expand – the award of substantial funding for genuinely transformative projects. Our work isn’t just about multimillion pound projects, however. In 2016/17 we made payments of almost £1m from funds earmarked for particular wards or services. These payments, which averaged £640 each, paid for smaller-scale initiatives such as developing bereavement kits for children, refurbishing a room for teenage patients and buying cardigans for elderly patients. Sometimes it is the little things that make the difference. If we are to maintain increased levels of grant-giving, we need to make a step-change in fundraising.
Our communities team works with the local community as well as staff and patients in the hospitals to develop awareness of Barts Charity and the work we support. Our major gifts team is building our profile with potential corporate and private supporters, recognising the important role that these organisations and individuals can play in helping us to achieve our mission. Over the past 12 months, we have worked hard to take the Charity to a new level. I would like to thank our staff, the Trustees, our Ambassadors, as well as our many donors, for their support. Their commitment and enthusiasm provides the platform that enables the Charity to help the remarkable people at Barts Health and SMD deliver great healthcare to the people of East London and beyond.
Paul Rawlinson Chairman
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In 2016/17 Major new projects funded:
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46
Barts Health
School of Medicine and Dentistry
Research
Patient care Community
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ÂŁ12,000,000 Totalling over
This year our funding has resulted in:
....as well as hundreds of smaller initiatives across the hospitals we support
85,000 children
served by the new Rainbow Centre in Newham
4,000 radiotherapy sessions
delivered by the Saturn linear accelerator
1,300 festival-goers
tested at the sexual health bus
1,200 attending
our first music event #TransformTrauma
22,000 volunteers
recruited for genetic research in East London
600 children in East London special
schools benefiting from tooth-brushing scheme bartscharity.org.uk
Annual Report 2016/17
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Our communities
2.5m Population served by Barts Health
Our funding benefits some of the most vulnerable and disadvantaged communities in East London. Barts Health’s hospital and community services reach a population of some 2.5 million people across East London – residents of some of the most economically deprived and ethnically diverse communities in the UK. Many health conditions show a strong association with poverty. Communities in East London are particularly badly affected by cardiovascular disease and metabolic conditions such as diabetes. Levels of childhood obesity are among the highest in the country. Air quality is poor, and levels of respiratory disease and asthma are well above national averages. Ethnic background also has a significant influence on health. East London is home to many people of South Asian heritage, who are at particular risk of cardiovascular disease and diabetes.
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Annual Report 2016/17
East London and beyond
Our funding is helping to ensure that East London’s disadvantaged communities receive the highest possible standards of healthcare. Barts Health’s catchment area also includes the business areas of the City and Canary Wharf, whose populations also have particular health needs. Furthermore, our Barts Health partners also provide a range of specialist services that benefit patients from wider areas of London, the South-East and sometimes even further afield. Much of the research we fund is tailored to the needs of local communities and improves the care and services they receive. In addition, the results of this research often have much wider implications – feeding into improved medical practice nationally and internationally.
bartscharity.org.uk
300 21% 15 Number of languages spoken in London
Percentage of London population living in poverty
Local average
Hackney Healthy life expectancy at birth (F)
Waltham Forest
104.7
72.8
38.5
Prevalence of diabetes
8.5%
6.5
Children in low-income families
41.9%
19.9
Respiratory disease premature mortality (M) (Annual deaths per 100,000 population)
Newham
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years
120
Cardiovascular disease, premature mortality (M) (Annual deaths per 100,000 population)
Tower Hamlets
64.1
years
3.1
(Households in temporary accommodation per 1,000 households)
Barking and Dagenham
National average
21.1
Homelessness
Redbridge
58.7
Difference in life expectancy in years between richest and poorest areas of London
%
%
Data taken from Public Health England’s Public Health Outcomes Framework. See www.phoutcomes.info for definitions of data.
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Annual Report 2016/17
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Our partners Barts Health
Every year, Barts Health, England’s largest NHS Trust, delivers care to hundreds of thousands of patients – residents of East London and patients from elsewhere in the UK benefiting from its specialist services.
In 2016/17 we awarded £3.2m to Barts Health across 46 projects, providing state-of-the-art equipment, supporting innovative new ways of delivering care, and enhancing hospital environments. Our funding is enabling Barts Health hospitals to make step changes in the care they provide – keeping
Barts Health at the forefront of healthcare innovation and ensuring patients benefit from the very latest technologies and ways of working. Across its five hospitals, Barts Health provides services for people of every age, from newborns to those nearing the end of their lives. Its hospitals are the first point of call
Mile End Hospital
A community hospital in the heart of Tower Hamlets Provides a range of services to local communities, including inpatient, rehabilitation, mental health and community services
St Bartholomew’s Hospital
The UK’s oldest hospital, dating back nearly 900 years National centre of excellence for cancer care Home to the world-leading Barts Heart Centre
Waltham Forest
Hackney
Tower Hamlets
The Royal London Hospital
A major teaching hospital providing local and specialist services Includes one of the UK’s largest children’s hospitals, a major dental hospital and leading renal unit Home to nationally important trauma services
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bartscharity.org.uk
Barts Health at a glance
England’s largest NHS Trust, with a turnover of £1.4bn
for local communities, and in many fields are also nationally important centres pioneering new approaches to care and treating patients from much further afield. In a multitude of areas, from cardiac care to children’s orthopaedics, Barts Health delivers unrivalled levels of care.
Employs more than 16,000 people across five hospitals Provides care to some 2.5 million people in East London
and beyond
Treats more than 6,000 patients every day Nationally recognised expertise in multiple fields,
including cardiac care, paediatrics, cancer, children’s orthopaedics and trauma
Barts Heart Centre Whipps Cross University Hospital
A large general hospital providing a full range of inpatient and outpatient services, including a 24-hour A&E department A centre of excellence for several specialist services, including cardiology, urology and acute stroke care
Leading the battle against heart disease, the biggest cause of death in the UK. The UK’s largest heart centre, treating 80,000 patients a year Performs more heart surgery and heart scans than any other centre in Europe Introducing a new model of care that could save 1,000 lives a year A key partner in a £10m Barts Charity initiative pioneering new approaches in cardiovascular medicine
Redbridge
Major Trauma Centre
Exploring innovative new ways to treat trauma, the biggest cause of death and disability in young people in the UK.
Barking and Dagenham
One of the country’s leading trauma centres and the busiest major trauma centre in Europe
Newham
Treats more than 2,500 seriously injured people every year
Newham University Hospital
A busy district hospital providing a full range of services to local communities Particularly noted for its orthopaedic services Site of the completely revamped Rainbow Centre for children and young people (see page 18)
bartscharity.org.uk
Led an influential review of London’s trauma services, leading to a city-wide reconfiguration of services A key partner in the Centre for Trauma Sciences, set up with £3m of our funding, which is carrying out groundbreaking research on serious injury and ways to reduce its long-term impact
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Our partners Barts and The London School of Medicine and Dentistry By working closely with Barts and The London School of Medicine and Dentistry (SMD), we are able to fund medical research that will shape the future of healthcare at Barts Health, in the UK more widely and globally. In 2016/17, we awarded £8m for 43 new grants to SMD, and at 31 March 2017 SMD researchers were undertaking 127 Barts Charityfunded research projects. Part of Queen Mary, University of London, SMD aims to improve the health and wellbeing of people throughout the UK and beyond through research and teaching excellence. It is home to scientists working on a range of conditions affecting local populations such as heart disease, cancer, TB, asthma, diabetes, HIV and high blood pressure. The expertise of SMD researchers spans all areas of medical science, from genetic, molecular and cellular studies to work in primary care and population health. In multiple areas, SMD researchers are nationally and internationally recognised experts in their fields. As well as working to understand disease and develop innovative new treatments, they are also exploring practical matters such as how healthcare can best be delivered to patients. The uniquely cosmopolitan makeup of East London populations provides a valuable resource for researchers. By participating in research, local people are helping researchers understand how conditions affect particular groups, and how treatments can be better tailored to them. Working in state-of-the-art facilities close to Barts Health hospitals, scientists in the SMD research institutes and the Institute for Health Sciences Education collaborate closely with clinical colleagues, to train future generations of doctors and researchers, to engage patients in research, and to accelerate the development of new treatments and drive forward changes in clinical practice. 8
Annual Report 2016/17
Barts Cancer Institute One of the top five cancer research centres in the UK A designated Cancer Research UK Centre of Excellence Conducts wide-ranging studies on cancer, spanning cancer cell biology, diagnosis and development of innovative new treatments
Blizard Institute The largest SMD Institute, carrying out the full range of laboratory, clinical, and primary care and public health research Has strong links with the nearby Royal London Hospital Includes the Centre for Trauma Sciences (see page 7) Includes the newly funded Barts Research Centre for Women’s Health (see page 12)
SMD at a glance…
One of the UK’s leading medical and dental schools, training
new doctors and undertaking ground-breaking research
More than 3,200 students and 1,500 members of staff Major sites in Whitechapel and Charterhouse Square, close to
Barts Health hospitals
Ranked as one of the top five medical schools nationally in the
latest Research Excellence Framework (REF) exercise*
Ranked top medical school in London in the National Student
Survey and second in Medicine nationally in the Guardian University Guide
* The Research Excellence Framework (REF) is the national system used to assess the quality of research in UK higher education institutions.
bartscharity.org.uk
Institute of Dentistry Ranked top dental school in UK for research in latest REF Occupies state-of-the-art premises at The Royal London Dental Hospital, housing the most modern and technologically advanced equipment in the UK
William Harvey Research Institute A world-leading centre of research into cardiovascular, endocrine and inflammatory diseases Specialises in the integrated application of multiple approaches to understand and treat disease Situated close to St Bartholomew’s Hospital and plays a key role in Barts Heart Centre (see page 7)
bartscharity.org.uk www.bartscharity.org.uk
Wolfson Institute of Preventive Medicine An internationally influential centre focusing on prevention of disease and disability Has run multiple major clinical trials demonstrating the benefits of preventive approaches Particular strengths in cancer, cardiovascular disease, psychiatric conditions and environmental risk factors for disease, including diet Includes the newly funded Barts Centre for Preventive Neurology (see page 14)
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Our supporters We are indebted to our many supporters whose fundraising, volunteering and other tireless work enables us to achieve so much. Every year, hundreds of people help us achieve extraordinary things in many different ways – by running marathons, organising bake sales or finding other imaginative ways to fundraise. Many supporters choose a cause close to their heart – whether it is directly supporting a hospital, a particular ward, research or one of our
An inspiring night of music to Transform Trauma
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appeals – and we ensure that 100% of the donations they make will be allocated to their chosen cause. We have recently launched the Barts Charity Champions network to help spread awareness of Barts Charity among the staff and patients of Barts Health. Champions, usually hospital staff, will act as a vital link between us and potential supporters, both spreading the word about donating and raising funds, and identifying how income from
supporters might be used to make the biggest difference. This is in addition to our network of Barts Charity Ambassadors, who do invaluable work on our behalf promoting and supporting our activities in the wider community. Thank you to all the individuals, local businesses and other organisations that support us.
A live music event provided Saturday night entertainment for more than 1,200 young people in November 2016 – and helped raise awareness of trauma and the importance of trauma research. Transformation, our first ever music event, featured four notable and up-and-coming artists – Becky Hill, Beach Baby (below), Kojey Radical and Rukhsana Merrise (left). The event was hosted by Sophie Morgan, co-host of Channel 4’s Paralympic coverage, who was paralysed from the waist down following a car accident when she was just 18. Following the live performances, a 700-strong crowd stayed on for the after-party, curated by Mercedes Benson, hosted by Kojey Radical and featuring Slocal, Faded and FutureSNDS. The event, held at Shoreditch’s Village Underground, also saw special appearances from three inspiring trauma survivors: Chris, who was knocked off his bike by a car; Sabrina, who was shot while on a night out; and Ben, who was paralysed from the waist down in a motorbike accident. The survivors were joined on stage by Dr Ross Davenport, a surgeon at The Royal London Hospital Trauma Centre, who highlighted the significance of trauma – it is the biggest cause of death and disability of young people in the UK – and of trauma research and our trauma appeal. The event was so well received that we’re doing it again – with the 2017 gig seeking to build on the impact from 2016 to raise more money and awareness for vital trauma research through our trauma appeal.
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Santa’s smiles and Egbert’s eggs Being in hospital during special occasions can be particularly difficult – that’s why our Easter and Christmas appeals aim to spread a little joy across the hospitals we support during these holidays. Our seasonal appeals, Egbert’s Eggs-traordinary Challenge and Send a Smile With Santa, ensured
that every child and older patient staying in our hospitals received a gift at Easter and Christmas. The appeals raised over £12,000, helping to support the work of staff in the care they give on the paediatric and older people’s wards throughout the year.
Thank you so much to the people who organised this, it is just the small things and this is such a lovely gesture, so appreciated!” Patient
Business leaders try their hand at medicine Courtesy of Beaufort Securities, some 300 influential and senior business leaders enjoyed an entertaining drinks reception in the Great Hall of St Bartholomew’s Hospital – while also raising more than £20,000 for Barts Charity. The reception, held on 2 November 2016 and hosted by Tanvier Malik, Chief Executive Officer of Beaufort Securities and a Barts Charity Ambassador, raised over £20,000 for life-saving equipment and groundbreaking research at Barts Heart Centre.
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Many local organisations donated prizes for an auction and raffle – including a night’s stay at the Groucho Club, dinner and drinks included, thanks to the generosity of another Barts Charity Ambassador, Matthew Hobbs, Managing Director of the Groucho Club. Attendees also had the chance to glimpse some of the wonders of modern medicine at Barts Heart Centre and to try their hand on high-tech simulators used in the education and training of Barts Health clinicians.
Santa’s Little Helpers
Staff from local businesses brought some festive cheer to children in hospital over Christmas. Continuing a Christmas tradition, staff from financial services company CME Group (below) built a special Christmas grotto at the healing space at The Royal London Hospital for the children’s Christmas party.
CME staff are skilled grotto constructors: they also created one at Newham’s Rainbow Ward back in 2014. They went on to donate £11,500 towards its transformation into the Rainbow Centre (see page 18), and plan to return to Newham and apply their grotto-building skills in 2017. Meanwhile, Bank of Montreal staff continued to be hugely generous supporters of the Children’s Hospital at The Royal London. In 2016, they raised more than £32,000 in their annual Christmas fundraising appeal for the hospital Play Team, which will enable it to organise arts and crafts events, parties, and music therapy for young patients.
Christmas fundraising focused on a frenzied 30-hour period, culminating in an evening event in which Managing Directors Bill Smith, Rob Yeung and Tony Hebdon performed a hearty rendition of Jingle Bells (above), and thanked staff for their outstandingly successful efforts.
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Research Impact of our research Our research is an investment in the future of healthcare. The wide-ranging studies we fund generate new knowledge – about the origins and nature of disease, how it can be prevented or treated, and how healthcare can best be delivered. This new knowledge will benefit a wide range of patients – people treated in Barts Health hospitals, members of local communities, and even patients from across the UK and worldwide.
NEW FUNDING
Safeguarding the health of mothers
The new Barts Research Centre for Women’s Health is studying innovative ways to improve the wellbeing of women and their unborn babies. Pregnancy and childbirth can be times of great joy, but complications can threaten the health of mothers and their babies. To address these dangers, SMD researchers created the Katherine Twining (KT) network dedicated to women’s health, spanning academics and clinicians at multiple sites across North and East London, and involving local women. Collectively, the KT network sees over 50,000 births a year, and serves an ethnically diverse population of more than 2 million women at notably high risk of maternal and newborn complications. This network has underpinned an innovative programme of research addressing key issues in maternal and neonatal health. Now, thanks to our substantial new funding, Barts Research Centre for Women’s Health
(BARC) is being created with plans for landmark studies that could greatly benefit mothers not just locally, but nationally and internationally as well. The existing programme includes two trials funded by Barts Charity. The first – the ‘ESTEEM’ trial – is testing the potential benefits of a Mediterranean diet and cooking with olive oil during pregnancy. The second trial – ‘PrePro’ – is exploring whether probiotic supplements alter the composition of microbes in the vagina and lower the risk of preterm birth. The new funding will support four further studies examining key issues spanning conception, pregnancy, childbirth and early motherhood (see Box). These feasibility studies will generate data to support applications for largescale clinical trials. Funding will also strengthen connections between the many different partners across academia and in primary and secondary
care, and support the training of researchers. BARC will also have a strong commitment to patient and public engagement; members of the local community will contribute to the management of BARC, and input into choice of research topics and design of studies. As well as promoting buy-in and encouraging participation in research, this will ensure that the Centre tackles the issues that really matter to local populations and generates findings that make a real difference to women’s health. £2m 2017 Prof. Shakila Thangaratinam, Professor of Maternal and Perinatal Health, and Prof. Khalid Khan, Professor of Women’s Health and Clinical Epidemiology, SMD
At a glance…
The project: Funding to establish a new Barts Research Centre for Women’s Health (BARC). What’s being done: BARC will study key issues in pregnancy, including diabetes prevention and treatment of bleeding during childbirth. Members of the BARC team (left to right): Amy Thomas, Dr Jahnavi Daru, Prof. Shakila Thangaratinam, Yvonne Muwalo and Dr Julie Dodds.
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Impact: The research could improve the health of women and their unborn babies locally, nationally and internationally.
bartscharity.org.uk
SUCCESS STORY
A clear vision
The trial introduced me to new types of food, like different types of nuts, and new recipes. I stuck with the diet after Irewamiri was born – I feel healthy, I feel good, I feel so happy! ” Yetunde Awodeyi ESTEEM trial participant
Pilot studies being undertaken by BARC: Gestational diabetes: Use of a nutritional supplement, myo-inositol, to prevent diabetes in pregnancy (gestational diabetes), which affects nearly 2,000 local women every year. Type 2 diabetes: Use of the diabetes drug metformin and a Mediterranean diet to prevent type 2 diabetes developing after birth in women with gestational diabetes. Halting bleeding: Earlier use of a blood product, cryoprecipitate, to stop bleeding during childbirth. In vitro fertilisation: Use of novel imaging methods to identify the most suitable embryos for use in in vitro fertilisation treatments.
bartscharity.org.uk
A new treatment may soon be available for the most common form of blindness in later life. Age-related macular degeneration (AMD) – damage to the central, most sensitive region of the retina, leading to a gradual erosion of central vision – is a frequent cause of sight loss in older people. The most severe form of AMD, so-called ‘wet’ AMD, affects some 40,000 people in the UK. Treatments do exist, but they do not work for all patients, and alternatives are urgently needed. At SMD, Dr James Whiteford and Dr Giulia De Rossi have been exploring the processes that lead to AMD – abnormal growth of blood vessels at the back of the eye. Conventional treatments block the action of a protein known as VEGF, which stimulates the growth of new blood vessels, but Dr Whiteford has identified a potential new way to prevent blood vessel formation. He has discovered a small protein fragment that occurs naturally in the body and acts as a brake on new vessel formation. His group has gone on to show that a manufactured version of this protein fragment, known as QM107, is a potent inhibitor of blood vessel formation – and hence could be a much-needed new treatment for those who do not respond to existing therapies.
At a glance… The project: Advancing a potential new drug treatment for ‘wet’ age-related macular degeneration (AMD). What has it shown: Positive results on safety and inhibition of new blood vessel formation, the root cause of AMD. Impact: The studies are a significant step towards clinical trials, and ultimately a new treatment for the most common form of blindness affecting older people.
Our funding has enabled Dr Whiteford to generate extremely encouraging data on the safety and healing powers of QM107 in laboratory models of AMD – an important step towards clinical trials and potentially a new option for people losing the precious gift of sight. £269,689 2016 Dr James Whiteford, Senior Lecturer, Centre for Microvascular Research, SMD
As well as funding, Barts Charity provided us with valuable advice on how we might turn an exciting scientific discovery into a product that benefits patients.” Dr James Whiteford Senior Lecturer, SMD
Blood vessel growth in the retina without (top) or with (bottom) QM107 treatment. Annual Report 2016/17
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Research
Saving the brain NEW FUNDING
At a glance…
The project: Enabling the Wolfson Institute of Preventive Medicine to establish a new Centre for Preventive Neurology to research brain and nervous system disorders. What will it show: Whether simple treatments have the potential to prevent or delay Parkinson’s disease, vascular dementia and related conditions, and multiple sclerosis. Impact: If shown to be effective in large-scale trials, the treatments could help hundreds of thousands of people live longer, healthier lives.
NEW FUNDING
Pioneering a new era in cancer therapy
£152,265 2016 Prof. John Gribben, Centre Lead, Centre for Haemato-Oncology, SMD, and Consultant Haematologist, Barts Health 14
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Simple treatments may be able to prevent or delay key disorders affecting the brain and nervous system – Parkinson’s disease, vascular dementia and multiple sclerosis. Disease prevention is central to population health issues such as heart disease and cancer. Now, our funding is enabling the Wolfson Institute of Preventive Medicine to extend this approach to diseases affecting the brain and nervous system – conditions that affect a large and growing number of people in the UK. The Wolfson Institute, led by Professor Jack Cuzick (left, seated), is a world leader in clinical trials of preventive treatments for cancer and other conditions. The new funding is enabling the Institute to link up with neurologist Professor Gavin Giovannoni (left, standing) to map out a new field of research in brain and nervous system disorders, with a particular focus on Parkinson’s disease, brain conditions linked to blood vessel damage (in particular vascular dementia), and multiple sclerosis. Brain conditions generally develop gradually, with damage to brain tissue accumulating over time. Once someone has developed symptoms,
Six up-and-coming young doctors are carrying out ground-breaking research on an exciting new approach to cancer treatment – immunotherapy. In recent years, spectacular progress has been made in a novel way of treating cancer – mobilising the body’s own immune defences to attack cancer cells. In fact, the idea is an old one, but until recently it has had limited success. Now, though, a better understanding of tumour biology and new experimental tools have reinvigorated the field. The principle is a simple one. The immune system recognises and attacks ‘foreign’ material such
as bacterial invaders. Cancer cells are abnormal so should also be attacked as foreign. But as cancers develop, they protect themselves by interfering with immune responses. By preventing this interference, and providing additional boosts to immune responses, researchers are bringing the full force of the immune system to bear on cancers. Cancer consultant and researcher Professor John Gribben (left) is one of those in the vanguard of developing and testing new therapies that reactivate immune responses against cancers. He is also nurturing the next generation of clinical and research leaders who will be developing bartscharity.org.uk
it may be too late to change the course of disease. Early detection and prompt treatment, before symptoms are apparent, could ensure that the disease is stopped in its tracks or at least delayed. The new work has two overarching aims: firstly, to develop methods to identify people at high risk of developing a condition; and secondly, to provide initial data to demonstrate that simple treatments can delay the onset of disease (see Box, right). If early results are promising, the team will apply for funding for the large-scale clinical trials required to confirm the effectiveness of treatments. With an ageing population, brain-related conditions such as vascular dementia are a growing concern. Delaying the onset of such conditions could ensure people live longer in good health, and markedly reduce demands on the NHS.
Brain diseases such as dementia are among the greatest public health challenges of the 21st century. By spotting them early, we may be able to prevent or delay them – and help people age more healthily. ” Professor Jack Cuzick CBE Director of the Wolfson Institute of Preventive Medicine, SMD
Condition Parkinson’s disease
Nicotine patches (nicotine appears to protect against Parkinson’s disease)
Vascular dementia (and other conditions linked to impaired blood vessel function)
– Low-dose aspirin – Polypill (a single pill containing multiple medications that benefit the heart and circulatory system)
Multiple sclerosis (MS)
Vaccination against Epstein–Barr virus (a common virus that appears to increase the risk of MS)
£1.5m 2017 Prof. Jack Cuzick, Director of the Wolfson Institute of Preventive Medicine, SMD, and Prof. Gavin Giovannoni, Professor of Neurology, SMD
From top left: Dr James Aries, Dr Ciara Freeman, Dr Robin Sanderson, Dr Ed Truelove, Dr Mark Schwarzbich, Dr Frances Seymour.
these pioneering new treatments and testing them on patients. We are playing our part by funding the research of six trainee clinicians who are specialising in a range of blood cancers where new treatments are urgently needed. The group are taking a step back from their clinical training in order to develop their research skills and gain a PhD. Scientific research is generating a deeper understanding of the tricks that cancers use to protect themselves from immune defences. Doctors trained in science, like our young clinicians, will play a vital role in using this new understanding to improve treatments for patients. bartscharity.org.uk
Potential treatments
At a glance…
The project: Funding for clinical research fellows in the Centre for Haemato-Oncology. What’s being done: Six fellows specialising in blood cancers are taking time out from clinical training to carry out research leading to a PhD. Impact: The fellows’ research will accelerate the development of novel treatments, and their research training will also make them ideally placed to pioneer the application of novel treatments in patients.
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Research
At a glance…
The project: Establishing the Barts Early Arthritis Referral Centre to support prompt assessment of patients and enrolment into research. What has it achieved: Better care of patients, enhanced understanding of disease, and improved enrolment into research studies. Impact: Identifying signatures of treatment response will enable doctors to choose the medications most likely to work on their individual patients. SUCCESS STORY
Personalising treatment for arthritis Through the Barts Early Arthritis Referral Centre, patients are benefiting from improved control of disease, and are contributing to research that could transform patient care. Rheumatoid arthritis is common, painful and can severely affect any joint in the body and, consequently, people’s daily lives. Early diagnosis is crucial, so treatment can limit further joint damage, and is central to the work of the Barts Early Arthritis Referral Centre, which we awarded funding to establish in 2008. The Centre has already proven a resounding success. It sees some 2,000 patients a year and, compared with patients receiving ‘standard’ care, the condition is now better controlled, more patients are in remission, and fewer are on expensive ‘biologic’ therapies because earlier treatments have failed. £498,438 2008 Prof. Costantino Pitzalis, Head of the Centre for Experimental Medicine and Rheumatology, SMD 16
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The Centre, led by Professor Costantino Pitzalis, also lies at the heart of a major programme of research, the main aim of which is to identify ‘signatures’ that predict whether patients will respond to drug treatments. Currently, patients begin on simple drugs and progress to more complex treatments, including biologics, if they do not respond. Yet 40% of patients do not respond to their first biologic treatment, and doctors have to use trial and error to find the therapy most suited to each patient. With local NHS bodies spending £12m on biologics, not only are patients not benefiting from the treatment but also substantial sums of money are being wasted.
Professor Pitzalis and colleagues have pioneered a method of minimally invasive ultrasoundguided biopsy, to extract small amounts of tissue from patients’
joints. These samples undergo numerous tests to see if any features of the sample are associated with response to drugs. The team has already identified markers associated with nonresponse to first-line drugs, and in the long term hopes to identify markers that could be used to give the right drug to the right patient first time. The Centre has developed a close relationship with patients, and most agree to take part in research studies – enabling the
The Barts Early Arthritis Referral Centre has ‘normalised’ research – it’s seen as the natural thing to do, to take part in research. Patients get great treatment, but they are also ensuring that patients in the future will get even better treatment.” Zoe Ide A Director at the National Rheumatoid Arthritis Society and patient advocate and adviser for the Barts Early Arthritis Referral Centre
bartscharity.org.uk
NEW FUNDING
A breath of (not so) fresh air Exposure to London’s polluted air could be making children more vulnerable to asthma. Children living in urban environments are known to be at increased risk of respiratory conditions such as asthma. Air pollution is the likely reason why – and Dr Abigail Whitehouse, a paediatrician awarded one of our Clinical Research Training Fellowships, is hoping to show exactly how pollution is affecting the lungs of London’s children. Asthma is a sign that immune cells in the lung are overactive. Potentially, this could be because they are being stimulated by pollutants entering the lung. To test this idea, Dr Whitehouse has been collecting sputum samples from the lungs of children in London schools. She has used these samples to analyse the
responses of a specialised type of cell – dendritic cells – which detect and respond to foreign matter entering the lung. She is looking to see whether air pollutants are affecting the way that dendritic cells activate other immune cells in the lungs – thereby increasing the risk of asthma. Alongside her research, Dr Whitehouse has been involved in educational projects helping schoolchildren understand the likely impact of pollution, and has made regular appearances on television discussing the impact of pollution on young people.
At a glance…
The project: Analysing immune cell activity in the lungs of children exposed to air pollution. What will it show: Whether air pollution is causing changes in the specialist cells in the lung that stimulate immune responses. Impact: The results could reveal how air pollution increases the risk of asthma – strengthening the case for stricter control of air pollution.
£59,980 2016 Dr Abigail Whitehouse, former Clinical Research Fellow, SMD
My Barts Charity Fellowship enabled me to carry out research alongside my clinical training – helping me achieve my ultimate ambition of combining research and clinical practice in paediatrics.” Dr Abigail Whitehouse
Centre to undertake numerous additional projects. Professor Pitzalis’s team has secured more than £20m from national funding bodies, and has trained more than 40 fellows in the biopsy technique across Europe and the USA.
Barts Early Arthritis Referral Centre
2,000 patients a year More than 600 patients enrolled in trials 89% of patients being treated Sees around
within 3 months (50% in routine care)
25% of patients in remission (16% in routine care)
30% on expensive biologics (40% in routine care)
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Patient care Transforming patient care Our funding is enabling our partner hospitals to deliver outstanding levels of care to the people living and working in East London. Barts Health hospitals provide exceptional care to thousands of patients every year. The funding we provide takes this care to another level. We help the hospitals acquire stateof-the-art equipment and pioneer innovative new ways of delivering care to patients. Our funding also ensures that hospital environments are inviting and patientfriendly – enhancing patients’ sense of wellbeing and speeding their recovery.
SUCCESS STORY
Discovering a new world at the end of the Rainbow The newly opened Rainbow Centre at Newham looks amazing – and is providing outstanding care to local children. Light, airy and calming, the Rainbow Centre is the epitome of a modern medical facility. From its bright and spacious waiting area to well-equipped day-care and inpatient wards, it has been designed from the ground up to provide the ideal environment for the care of local children. It is a far cry from the old Rainbow ward, where services were spread across the Newham site – and outpatients occupied a Portakabin. Opened in early 2017, the Rainbow Centre has united and integrated children’s inpatient, daycare and outpatient services. The Centre has also had a significant upgrade in its clinical facilities. It includes extra beds and new clinical equipment, including a state-of-theart stabilisation centre. There are also new areas for doctors and for team meetings, all close to patients should emergencies arise. The value of the new equipment was dramatically illustrated within days of opening, when an infant with multiple medical problems developed breathing difficulties. Previously, this would have meant a potentially hazardous trip across London to a specialist intensive 18
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care unit at another hospital, but Rainbow Centre doctors were able to stabilise him and continue his treatment at Newham. Great thought has gone into the planning of the new Centre, with the patient experience uppermost in everyone’s mind. As well as outstanding clinical spaces, it also includes indoor and outdoor play areas, a dedicated space for adolescents, a school resource room, and a parents’ room. These spaces are also proving their worth. The adolescent room, for example, was a godsend for a teenage girl with cancer having a difficult time with her treatment, providing her with a sanctuary when things were threatening to become too much for her. Staff are visibly happier in the new surroundings, which will undoubtedly help the hospital both recruit and retain highly sought after skilled nursing staff. Most importantly, though, Newham patients and their families are benefiting from an uplifting and comforting environment – and clinical facilities to rival the best in the UK. £6.85m 2015
“ We’ve been able to do new things. We’re one of the first district general hospitals to use ‘optiflow’ equipment to deliver oxygen, so young patients haven’t had to be moved to intensive care units. That makes a big difference.” Dr Akwasi Osei-Yeboah Rainbow Centre Paediatrician
bartscharity.org.uk
NEW FUNDING
A walk down Thistle Street
At a glance…
The project: Creation of the Rainbow Centre at Newham University Hospital. What’s been done: Transformation of dilapidated children’s wards into a state-of-the-art centre with integrated inpatient, outpatient and day care services, greatly enhanced clinical facilities, and a spacious and welcoming environment. Impact: Significantly improved quality of medical care and a much enhanced patient experience for Newham children and families.
Two wards at Newham University Hospital have had an artistic makeover – creating surroundings that are not only easier to navigate but also lift the spirits of older patients. Hospital wards can look much of a muchness, but visitors to Thistle Ward may be pleasantly surprised to encounter brightly coloured doors to patients’ rooms. The doors are the brainchild of artist Rebecca Thomson, a graduate of Central St Martins School of Art, who was inspired by post-war reconstruction in Newham, when residents began painting their doors in bright colours as a sign of optimism and hope. As well as Thistle Street, our funding has enabled artists to create more engaging environments in nearby Tayberry Ward. Walls and doors are adorned with images drawing inspiration from London landmarks and locations, the work of Central St Martins’ graduates Jessica Hook and Florence Meunier. The new spaces don’t just look more attractive – many patients cared for on the wards are living with dementia, and the art has been specifically developed to be calming and dementia-friendly to enhance the wellbeing of patients and hasten their recovery. £20,000
2016 Catsou Roberts, Vital Arts
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Patient care NEW FUNDING
The clinics are a ‘safe space’ in which patients – supported and encouraged by their peers – can practise ways of falling and getting back up, developing their confidence.” Harriet Smith Multiple sclerosis patient and facilitator of the falls group clinic
Expanding care for multiple sclerosis Thanks to new group clinics, multiple sclerosis patients are enjoying extra contact time with care staff. Patients with multiple sclerosis typically meet their consultants and other clinical staff for 15-minute checkups once or twice a year. This model is unsatisfying for patients and care staff alike. Patients rarely have time to go through all the issues affecting them, and clinical staff find themselves repeating the same advice to every patient. Thanks to a grant we made in 2016, Barts Health is piloting a new way of working – multiple sclerosis group clinics (right) – that addresses these issues. By seeing up to a dozen patients together, clinical staff can run longer sessions (typically four hours) covering issues in more depth. Clinics are focusing on three topics – falls, prevention of urinary tract infections and general lifestyle issues – and each will be run three times; patients can choose clinics most suitable to their needs. Sessions start with an ice-breaker, to relax patients and help them get
to know each other – and ensuring they participate fully and get the most out of the clinic. Each session includes one-to-one time where clinicians and patients can discuss and agree personalised care plans. Afterwards, a Google+ site enables patients to stay in touch with one another and share experiences. Listening to patients has prompted the team to rethink what a clinic can offer. In a supportive environment, patients can discuss issues that affect them in their daily lives, not just purely clinical issues such as medications. The response of patients so far has been highly positive. The team also hopes to see clinical benefits, such as reduced numbers of falls and fewer bladder infections. If initial results look positive, it plans to run a larger trial comparing the group clinic approach with routine care, generating evidence to support wider implementation – at Barts Health and potentially at other treatment centres too.
At a glance…
The project: Introducing group clinics for multiple sclerosis patients. What’s being done: Piloting of four-hour group clinics to replace 15-minute one-to-one consultations. Impact: More comprehensive support for patients, reducing their risk of falls and infections and improving their quality of life. £37,773 2016 Alison Thomson, Lecturer in Patient Public Involvement and Public Engagement in Science, SMD
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bartscharity.org.uk
At a glance…
The project: A new linear accelerator (‘linac’) for radiotherapy at St Bartholomew’s Hospital. What’s been done: Addition of a new linac, known as Saturn, has provided extra capacity to the radiotherapy department. Impact: Hundreds more patients have benefited from shorter, safer courses of treatment and a more reliable service.
It’s a hammer blow to be told you have cancer. But I can walk out of here knowing I’ve been cured.” M, breast cancer patient
SUCCESS STORY
Accelerating progress in cancer radiotherapy State-of-the-art radiotherapy equipment has helped to save the lives of hundreds of cancer patients. X-rays have been used therapeutically at St Bartholomew’s Hospital for more than 100 years. But the latest ‘linacs’ (linear accelerators) are a world away from those early tools. In 2010, fundraising by the Grand Lodge of Mark Master Masons enabled us to purchase a fifth linac, known as Saturn, for St Bartholomew’s Hospital – creating one of the best-equipped radiotherapy centres in the UK. Indeed in 2016, it became the first radiotherapy unit in London to be awarded the prestigious Macmillan Quality Environment Mark, in recognition of the excellent environment it provides to patients. Every day, Saturn delivers highly targeted X-rays to around 25–30 patients with a wide range of cancer bartscharity.org.uk
types. Saturn delivered 4,000 radiotherapy sessions in 2016/17, and some 26,000 since it was first installed. Importantly, it provides valuable additional capacity so that radiotherapy services can continue running smoothly even if another machine is taken offline for maintenance or repair. Saturn has built-in imaging abilities, so that tumours can be visualised during treatment and ensuring that X-rays are targeted precisely to cancerous tissue. As a result, much higher doses of radiation can now be safely delivered. Patients therefore benefit from much shorter courses of treatment, and are less likely to experience side effects as X-rays do not hit noncancerous tissue. In many cases, treatment is enough to cure them of cancer completely. Remarkably, image guidance is now so sophisticated that X-ray delivery can even be tailored to take account of small movements of tumours as patients breathe. Barts Health doctors are continuing to innovate with new imaging methods and combinations of treatments, including
radiotherapy alongside surgery and chemotherapy, to maximise the chance of success. “I can’t thank the donors enough,” says Dr John Conibear (below), Consultant Clinical Oncologist at St Bartholomew’s Hospital. “They’ve given us the tools to treat more people in more ways and with more success than ever before.” £1.3m 2010 St Bartholomew’s Hospital Radiotherapy Department
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Patient care
At a glance…
The project: Refurbishing wards and day rooms at Whipps Cross to make them more suitable for people with dementia. NEW FUNDING
What will it do: Make the hospital environment less confusing and create more welcoming spaces in which patients can recuperate. Impact: A greatly enhanced hospital experience for patients living with dementia.
Making hospitals ‘dementia-friendly’ £496,800 2016 Lucy Cosgrove, Dementia Clinical Nurse Specialist, Barts Health
A major refurbishment at Whipps Cross Hospital will create spaces better suited to patients living with dementia. Hospitals can be confusing and even intimidating places for people living with dementia. Patients can easily become disoriented, confused or distressed during hospital stays, potentially leading to agitation, difficult behaviour and slower recovery. Fortunately, there is a growing awareness of these problems and how hospital environments can be modified to provide a better experience for patients.
We hope the changes at Whipps Cross will open people’s eyes to what can be done to make hospital environments more dementia-friendly – in time, the needs of people living with dementia should be integral to the design of clinical facilities and all care-giving.” Lucy Cosgrove Dementia Clinical Nurse Specialist and lead on the refurbishment project
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Through our funding, Whipps Cross Hospital is refurbishing five ward areas, including two day rooms, to create spaces more suited to the needs of people living with dementia. Relatively simple changes can make a big difference – such as improving signage or using contrasting colours to make it easier for patients to navigate and make sense of their environment. Matt floors are being introduced – shiny polished floors may look nice but they can appear wet and slippery to people living with dementia. The refurbishment will create more engaging day rooms where patients can relax and chat. To stimulate conversation and reminiscence, pictures will be sourced from local museums and objects put on display. Notices and posters will be removed from cluttered walls and replaced with pictures – including the winning entries in a photographic competition run for patients, their families and staff (left). The refurbishment is part of a pioneering programme of work led from Whipps Cross promoting more dementia-friendly environments and care practices across Barts Health. bartscharity.org.uk
Creating chill-out space for adolescents SUCCESS STORY
£6,000
Adolescents in Acorn Ward at Whipps Cross now have their own private space to escape to. Rob Ross was so appreciative of the care he received on Acorn Ward as a child that he resolved to give something back. Thanks to his fundraising efforts, we have been able to provide funds to create a special room on the ward providing a sanctuary for adolescent patients. Children’s wards can be noisy, busy places, with little to occupy older children. Now, when they need to, teenagers can escape to the adolescent room – planned in partnership with the Barts Health Youth Empowerment Squad – and enjoy a games console, TV and table football, or just chill out in their own space.
Every kid needs time out and a free space that they can go to whenever they need to be alone or want to be with others facing similar things. Being able to have teenage activities as a distraction is one of the best painkillers for me when I am in hospital. ”
2016 Acorn Ward, Whipps Cross University Hospital
Lexie Edwards, 16 Member of Barts Health Youth Empowerment Squad
SUCCESS STORY
Chair necessities A new ‘biopsy chair’ means shorter and less stressful waiting times for women undergoing breast cancer biopsies. For the past ten years or so, Margaret Hazard and fellow breast cancer survivors (right) have been knitting, baking, and making marmalade to raise funds for the breast cancer unit at St Bartholomew’s Hospital. Thanks to their sterling efforts, we have been able to buy the unit an additional ‘biopsy chair’ – a reclining chair that allows the patient to sit or lie comfortably during what can be a lengthy procedure. Crucially, this means that staff can perform biopsies on two women at the same time – so the unit can see more patients and women spend less time waiting for bartscharity.org.uk
We are now able to perform the biopsies simultaneously in different rooms, which means we can see more women, reduce the anxious waiting time and speed up diagnosis. It’s made a huge improvement to the efficiency of our assessment clinics.” Anne Dean Senior Radiographer
a chair to become free. Margaret and her friends are continuing their fundraising efforts, which have also enabled the unit to enhance its wig and styling service, and to buy iPads so patients can complete their Health Needs Assessment questionnaires more easily.
£5,000 2016 Breast cancer unit, St Bartholomew’s Hospital Annual Report 2016/17
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Community Improving lives in the community Our work with local communities is helping people stay healthy and live longer. Extraordinary healthcare is about more than just what happens in hospitals. It’s also about working with communities to improve health and wellbeing, helping local people to live active and fulfilling lives. Many of the projects we fund therefore reach out to our local communities across East London, promoting healthy lifestyles and life choices, engaging local populations in research, and empowering communities to live healthier and happier lives.
NEW FUNDING
Brushing the way to better dental health
Children attending special schools in East London are benefiting from improved dental health, thanks to a new supervised daily toothbrushing programme. Stephen Hawking School in Tower Hamlets is a primary school for pupils aged between two and 11 with profound and multiple learning difficulties and complex
and severe medical needs. Most of the pupils have additional physical and/or sensory impairments. The children need high levels of support and care, and maintaining their oral health can be challenging. Moreover, many take medications that damage their teeth. Thanks to our funding, the children at Stephen Hawking School – and at five other special schools across East London – are benefiting from a specially developed supervised daily tooth-brushing programme provided by the local Community Dental Service. Liaising closely with a ‘dental champion’ at each participating school, the team has trained teaching assistants in special schools so that they can supervise and support the children during daily tooth-brushing sessions. The training covered issues such as general oral health, good toothbrushing practice, minimising
the risk of infection and how to support children who find toothbrushing difficult. Now, once a day, the children are helped to brush their teeth, using specially supplied brushes and toothpaste kept in ‘brush buses’ – storage boxes inspired by London’s double-deckers. The Community Dental Service has trained around 200 teachers and teaching assistants, who have themselves trained other school staff. In total, nearly 600 of London’s most vulnerable children have been helped to develop an important life skill, and can look forward to improved oral health and fewer teeth-related problems. £19,246 2016 Barts Health Community Dental Service
At a glance…
The project: A daily supervised tooth-brushing programme for East London’s special schools. What’s being done: Teaching assistants have been trained so that they can help children to clean their teeth properly. Impact: Better oral health and fewer dental problems in children attending special schools. 24
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SUCCESS STORY
Talking genes and health More than 22,000 volunteers from East London’s Bangladeshi and Pakistani communities have signed up for East London Genes & Health, one of Europe’s largest community genetics projects. In a well-thumbed desk diary, Beverley MacLaughlin records the number of people who have volunteered to take part in East London Genes & Health each week. Some weeks it is 150, others 250. By the end of March 2017, the numbers had surpassed a remarkable 22,000 – another milestone passed in the ultimate quest to reach the ambitious target of 100,000 volunteers. Launched in 2015 with Barts Charity as one of its original funders, East London Genes & Health seeks to answer a key question: why are people of Bangladeshi and Pakistani heritage at such high risk of heart disease and metabolic conditions such as diabetes? The answer could in part lie in genetic factors, so every volunteer is providing a saliva sample from which DNA can be extracted and analysed. Volunteers are also giving
researchers permission to access their anonymised health records and to contact them to take part in follow up studies. Beverley leads an energetic team of recruiters who spend their mornings visiting GP surgeries and clinics across East London talking to potential volunteers about the project. All members of the team are of Bangladeshi and Pakistani background, helping to overcome language barriers and build trust. Information is available in a range of languages, and the recruiting team can discuss the project in native tongues – particularly useful when the team meets people from areas such as the Sylhet district of Bangladesh, as written forms of the Sylheti dialect are rarely used. The team’s bridge building pays off – on occasion, people volunteer the second or third time they are contacted, or after they find out a friend or relation has signed up. Together, they are creating a resource that could help researchers uncover the secrets of diseases that have a deep impact on local communities.
At a glance…
The project: Promoting recruitment to the East London Genes & Health initiative. What’s being done: Some 100,000 volunteers of Bangladeshi and Pakistani heritage are being recruited to create a resource for research into heart and metabolic conditions in such communities. Impact: Ultimately, a deeper understanding of why these communities experience such high levels of disease, and potentially new treatments or ways to prevent disease.
£250,000 2012 Prof. David Van Heel, SMD and Prof. Richard Trembath, formerly SMD
Pakistani and Bangladeshi people have lots of genetic problems. If the doctors can find medicines and cures, it will be a gift to the coming generation.” Mr Rao Muhammad Aslam Pak Cultural Society, volunteer
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Community NEW FUNDING
Catalysing conversations about HIV A new film will use compelling human stories to get black African communities talking about hot topics in HIV prevention. A mum-to-be discovers her unfaithful husband has passed on an HIV infection. A victim of sexual assault fears he has been exposed to the virus. A gay man whose partner has HIV discovers his partner has a fiancée from a former life. A sexually liberated woman who successfully limits her risk of HIV infection tries to deal with her sister’s high-risk behaviour. These challenging themes form the narrative threads of a powerful new drama that aims to kickstart conversations about sexual health and HIV prevention in East London’s black African communities. The film is the result of a collaboration between Barts Health Sexual Health Services team and NAZ, a sexual health charity dedicated to working with black, Asian and minority ethnic communities. HIV has a big impact on black African communities, yet knowledge of many key issues in
At a glance…
The project: ‘Community Conversations’ – raising awareness of key issues in HIV prevention in black African communities. What’s being done: A hard-hitting drama is being filmed exploring key issues in HIV prevention. Impact: Increased awareness of important issues in HIV prevention and more open discussion of HIV and its prevention in black African communities. HIV prevention is low. Through the new project, funded by us and Public Health England, acclaimed film-maker (and NAZ employee) Joseph Adesunloye is producing a film exploring the intertwined stories of young black African people in East London affected by HIV. Each narrative thread is inspired by a real-life story. While each thread highlights a key issue in HIV prevention, and a medical advisory board will ensure that medical matters are portrayed accurately, Joseph’s primary aim is to create a compelling drama that will spark
discussion and debate among its target audience – young people aged 18–29 from black African communities – so they discover for themselves potentially lifechanging information. The film will include appearances from notable musicians, internet celebrities and other personalities well known to local communities. By telling stories that resonate with individuals, it will improve individual knowledge and awareness. But it may also have a wider impact, by chipping away at stigma and cultural attitudes that hinder attempts to tackle HIV.
£20,000 2017 Dr Vanessa Apea, Consultant in Genito-urinary and HIV Medicine, Barts Health
Conventional educational approaches to HIV prevention in black African communities are not working – it’s time we tried something more radical.” From left to right: Jennifer Kamara, Dr Vanessa Apea, Jade Anderson, Marion Wadibia, Joseph Adesunloye, Robert Hammond.
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Marion Wadibia Chief Executive Officer, NAZ
bartscharity.org.uk
NEW FUNDING
Olive has helped in so many ways, from shopping to hospital appointments and advice on breastfeeding. We meet and speak at least once a week on the phone. It would have been a real struggle without her.”
A helping hand for mothers-to-be The ‘Maternity Mates’ scheme is helping vulnerable expectant mothers cope with pregnancy, childbirth and looking after a new baby. For some women, pregnancy can be a daunting time – perhaps because they have had difficult pregnancies in the past, or have ongoing health problems, or are new to an area and do not have friends and family to offer support. The Maternity Mates scheme was set up in 2010 by Women’s Health & Family Services, a community charity, to provide additional support to such vulnerable women, all the way from pregnancy, through childbirth itself and the first few weeks of caring for a new baby. The programme works with midwife teams to identify women in need of extra help, and matches them with specially trained volunteers from local communities. Successful Maternity Mates pilot studies have been organised across parts of East London, and our funding has helped to extend the scheme to mothers in Waltham
bartscharity.org.uk
Rashida Mother of Ayeshe, one month
At a glance…
The project: Expanding the Maternity Mates scheme to Waltham Forest and Whipps Cross. What’s being done: Vulnerable local women are paired with trained volunteers who help them through pregnancy, childbirth and early motherhood. Impact: Women will experience less stress and more positive pregnancies, benefiting them and their babies. Forest and Whipps Cross. The Maternity Mates offer both practical and emotional support. They can be a reassuring voice through pregnancy and attend antenatal classes with their mumsto-be. They help them plan for childbirth, are present throughout labour, and help new mothers get to grips with breastfeeding. The bond between mother and mate can be extremely strong. It is not just mothers who benefit. Volunteers develop new skills, which can help them further their careers. The scheme has also helped to build stronger bridges between maternity services and local communities.
From heart-to-heart talks or just good company to practical help with new baby care, the scheme has helped more than 200 vulnerable women through a potentially difficult time. Now, some are themselves training to be volunteers, so they can help others in turn.
£20,000 2016 Felipe Castro Cardona, Consultant Midwife, Barts Health
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Governance Barts Charity is a company limited by guarantee (registration number 7168381) and a registered charity in England and Wales (registration number 212563). It is governed by Articles of Association most recently updated on 12 December 2016. It is fully independent of the Department of Health – the first NHS Charity to achieve this status (in July 2014).
Charitable purposes
Our charitable purposes relate to hospital services (including research), or to any other part of the health service associated with any hospital as our Trustees think fit. In practice, we focus our support for innovation in healthcare on the Barts Health group of hospitals and Barts and The London School of Medicine and Dentistry, part of Queen Mary University of London. (Find out more about our relationship with these key partners on pages 6–9.) Although we are careful to consult with representatives of grantee organisations to ensure alignment of strategic priorities and to secure the greatest impact from our funding, we retain our independence to act in the best interests of Barts Charity and the communities we serve.
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PROFESSIONAL ADVISERS Bank Royal Bank of Scotland 280 Bishopsgate London EC2M 4RB Auditors KPMG LLP 15 Canada Square Canary Wharf London E14 5GL Legal advisers
Trusteeship, Committees and Board Advisers
Barts Charity acts through its Board of Directors (who are known as Trustees). At the end of the reporting year, there were 14 such Trustees. All Trustees give of their time freely and no Trustee remuneration is paid. Details of Trustee expenses and related transactions are disclosed in notes 13 and 16 to the accounts. Trustees are required to disclose all relevant interests and register them with the Director of Corporate Services and, in accordance with Barts Charity’s policy, withdraw from decisions where a conflict of interest arises. Power to appoint new Trustees lies with the existing Trustees, in accordance with the provisions of our Articles of Association. All Trustees are appointed for a fixed term of not more than three years (renewable to a maximum of nine years in total), although the Board may decide to extend this maximum term for some Trustees in appropriate circumstances. The Board has established a series of committees so that much of the Charity’s detailed governance work can be conducted by groups of Trustees and specialist Board Advisers with the most relevant experience and expertise. Board Advisers are appointed for an initial two-year term, renewable to five years in total. Both new Trustees
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and new Board Advisers have an induction programme, during which they are familiarised with key constitutional and operating documents, meet senior Trustees and management, and tour the hospitals.
Bircham Dyson Bell 50 Broadway London SW1H 0BL Taylor Wessing LLP 5 New Street Square London EC4A 3TW Staff benefit advisers St James’s Place Beech House Brotherswood Court Great Park Road Bristol BS32 4QW Property advisers Gerald Eve LLP 72 Wellbeck Street London W1G 0AY Gryphon Property Partners 12 Austin Friars London EC2N 2HE Workman LLP Alliance House 12 Caxton Street London SW1H 0QS Investment adviser Cambridge Associates Ltd 80 Victoria Street Cardinal Place London SW1E 5JL Global custodian The Northern Trust Company 50 Bank Street Canary Wharf London E14 5NT Insurance broker Willis Ltd The Willis Building 51 Lime Street London EC3M 7DQ
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Governance TRUSTEES AND BOARD ADVISERS
Paul Rawlinson Chairman
Chartered Accountant; nonexecutive director of the Good Care group and Charles Wells plc; formerly partner and member of Executive Board of PricewaterhouseCoopers LLP.
William Medlicott Deputy Chairman
Andy Bruce
Sir Stephen O’Brien CBE
Partner, Global Head of Real Estate, Linklaters LLP solicitors.
Chairman and President of a number of charities and third sector organisations in healthcare and social enterprise; formerly Chairman of Barts Health NHS Trust.
Sally Flanagan
Ian Peters
Chartered Accountant; formerly Finance Director for ITV Broadcasting, part of ITV plc.
Director of Unquoted Investments at Caledonia Investments plc; formerly Head of Healthcare Investment teams at Private Equity investors, Permira and PPM Capital (now Silverfleet).
Chairman of Barts Health NHS Trust (ex officio Trustee).
Nick Anstee
Chartered Accountant and Senior Director at City law firm King & Wood Mallesons LLP; formerly Lord Mayor of London 2009/10.
Jessica Wanamaker
Solicitor; change leadership and development consultant; Council Member and Chair of External Relations Committee of Goldsmiths, University of London; Board Member and Company Secretary, Contemporary Applied Arts.
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Dominic Hollamby
Dr Thomas Round
Chartered Accountant; ViceChairman of Rothschild Bank, Global Head of Healthcare/Life Sciences and Pharmaceuticals; formerly partner at Arthur Andersen.
GP at the Bromley by Bow Health Partnership; Academic Clinical Research Fellow in Primary Care and Public Health Sciences at King’s College London.
Professor John Shepherd
Emeritus Professor of Surgical Gynaecology at Barts and The London School of Medicine and Dentistry; formerly Consultant Surgeon and Gynaecological Oncologist, the Royal Marsden Hospital, London, and Honorary Consultant at the London Clinic and King Edward VII Hospital, London.
Professor Ian Sanderson
Professor of Paediatric Gastroenterology, Barts and The London School of Medicine and Dentistry; Visiting Professor, University College London; Visiting Professor at Juntendo University, Tokyo, Japan; external faculty, Harvard Medical School, Boston, USA.
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SENIOR MANAGEMENT
Vijay Bharadia (Board Adviser)
Chartered Accountant; International Chief Financial Officer at the Blackstone Group; formerly First Vice-President and Co-Chief Financial Officer for European Equities at Merrill Lynch & Co.
Professor John Monson
Emeritus Professor of Clinical Endocrinology at Barts and The London School of Medicine and Dentistry.
Leopoldo Zambeletti
Strategic adviser to healthcare companies; director of a number of medical device manufacturers and pharmaceutical companies; formerly Managing Director, Head of Healthcare Investment Banking at Credit Suisse and JP Morgan, London.
Appointments and Remuneration Committee
Fiona Miller Smith Chief Executive
Paul Rawlinson (Chairman) Andy Bruce William Medlicott
Finance and Audit Committee William Medlicott (Chairman) Nick Anstee Vijay Bharadia Dominic Hollamby Paul Rawlinson
Grants Committee Paul Rawlinson (Chairman) William Medlicott Professor John Monson Sir Stephen O’Brien
 Dr Thomas Round Professor Ian Sanderson Professor John Shepherd Jessica Wanamaker Leopoldo Zambeletti
Fiona Bickley Director of Corporate Services
Francesca Gliubich PhD Director of Grants
Arati Patel Director of Finance and Operations
Investment Committee Leopoldo Zambeletti (Chairman) Andy Bruce Sally Flanagan William Medlicott Paul Rawlinson
Aneta Saunders Director of Community and Engagement
As at 19 July 2017 bartscharity.org.uk
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Finance Finance review and strategic report We enjoyed another excellent year as prudent investment and financial management delivered strong performance, supporting our new commitment to award up to £30m per year for at least the next three financial years. Total gross asset base: £ 460m (+£58m) Net assets: £422m (+£59m) Total charitable expenditure: £12.7m (–£13m) The Trustees confirm that they have referred to the guidance contained in the Charity Commission’s general guidance on public benefit when reviewing Barts Charity’s aims and objectives and in planning future activities and setting the grant-making policy for the year.
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Financial review
Spending review
Our proactive and prudent approach to the management of our investment portfolio and annual operating activities has delivered a 16.4% growth in assets for FY2016/17 (Figure 1). Annual growth has averaged 14.6% over the past five years, increasing net assets by 73%. Income has also increased, with the investment portfolio generating £13.7m (£11.7m in FY2015/16; Figure 2). Fundraising income for FY2016/17 was £3.7m.
Total expenditure for FY2016/17 was £16.1m (£28.6m in FY2015/16), of which £12.7m related to charitable expenditure (Figures 3, 4). This reduction in expenditure reflected a transitional year, as a new Chairman and Chief Executive were appointed and subsequently led a strategic review of the Charity’s activities. As the Chairman discusses in his letter on page 2, a new strategy was adopted in December 2016, committing the Charity to increasing our funding significantly to £30m per year for at least the next three financial years. This exciting strategy is now being implemented and we look forward to reporting progress in future Annual Reports. The total cost of generating funds – expenditure on fundraising activities and management of the investment portfolio – was £3.4m in FY2016/17 (£2.9m in FY2015/16). Of this figure, £2.5m relates to management of investments. Costs relating to financial investments (£1.7m) amount to less than 1% of asset value (exclusive of private equity and private credit). The annual spend linked to propertyrelated investments in FY2016/17 was £0.8m against an average asset value of £130.6m, representing 0.6% of asset value. The property assets are predominantly multi-let commercial properties in London and the South-East. Staff remuneration is determined by a salary survey carried out by specialist reward consultants. Jobs are benchmarked against similarly rated posts across all sectors in organisations based in London with a similar turnover.
bartscharity.org.uk
Net assets
Summary of expenditure
Figure 3:
450 400
£m
5% 11%
350
5%
300 250 200 150
79%
100 50
/1 7
6
16
/1 15
20
20
/1 4
14
20
3
13
/1
20
12 20
/1 5
0
Restricted funds Unrestricted funds Capital in perpetuity
Charitable activity
£12.74m
Fundraising
£0.89m
Financial investment management
£1.70m
Property investment management
£0.78m
Expendable endowment See note 1.3 to the accounts for details of fund structure
Figure 2:
Income
Figure 4:
20
Grant expenditure
30 £m
£m
25 15 20 10
15
10 5 5
0
17
5
6 /1
6/
20 1
15
20
4
3
14 /1
20
13 /1
/1
20
12 20
7 /1 16
6 15
/1
20
20
20
14 /1
5
4 /1
/1 12
13
3
0
20
We conduct an annual review of our Statement of Investment Policies and Objectives, which sets out our financial and investment goals. Endowment and unrestricted funds are intended to last into perpetuity and are managed accordingly. Hence the investment policy provides for long-term stability, preservation of purchasing power, and liquidity sufficient for the funding of grant-making and other operating activities. It also sets out guidelines for the portfolio’s risk profile, strategic asset allocation and investment restrictions. During FY2016/17, the strategic asset allocation of the investment portfolio (Table 1) was revised to include larger target allocations to private equity and private credit, to take advantage of higher potential long-term risk-adjusted returns than are achievable with marketable alternatives. This also allows for access to differentiated exposures outside of public markets, including investments with high social impact. The resulting high-quality portfolio will continue to be diversified, robust, and generate a reliable source of income and market appreciation to support our grant-giving. Financial investments are principally held in 16 investment funds, allowing for diversification by asset type, risk profile, geographical exposure and manager style (active and passive). We have additional holdings in both private equity and private credit, which account for only 3.3% and 2.9%, respectively, of the total investment portfolio, although these allocations are targeted to grow over the next 3–5 years.
Figure 1:
20
Investment review
Other income Legacies and donations Stocks, shares and cash dividends Property
bartscharity.org.uk
Annual Report 2016/17
33
Finance
Investment review cont.
Measured against standard benchmarks, the investment portfolio is achieving sound performance during continuing economic uncertainty, with growth of 18.4% in FY2016/17 (Table 2). The target for the portfolio is an average real return of 4.5% per year over a rolling three-year period; as of 31 March 2017, this has been comfortably exceeded, with a return of 13.7% annualised per year over the last three years. Long-term investment returns have exceeded market benchmarks and the performance of peers. Several factors have contributed to this success: a realignment of direct property holdings to focus on lower-risk ‘core’ investments; an emphasis on investment in straightforward cash-yielding strategies; and remaining fully invested in order to minimise the low yield on cash deposits. We have also made a tactical shift from sovereign bonds to public and private credit in response to a perceived overvaluation of the former. Investment performance is monitored quarterly by our Investment Committee with the assistance of Cambridge Associates Ltd, which provides advice and monitoring services for the financial portfolio. Gryphon Property Partners provides similar support for the property portfolio, while Workman provides tactical advice and management services.
Table 1:
Asset allocation FY2016/17 (%)
FY2015/16 (%)
FY2014/15 (%)
Target (%)
Growth drivers (public and private equity)
49.0
46.7
47.1
51.0
Diversifiers (public and private credit)
14.2
9.9
8.8
11.0
Inflation hedging (property and commodities)
32.2
35.1
31.7
32.0
Deflation/disaster hedging (fixed income and cash)
4.5
8.3
12.4
6.0
Table 2:
Total investment portfolio performance Cumulative trailing 1 Year (%)
Annualised trailing 3 Year (%)
Annualised since November 2005 (%)
Total assets
18.4
13.7
10.1
Long-term policy benchmark
15.2
10.1
6.3
Value added
3.2
3.6
3.8
Total assets excl. private investments
21.5
9.5
6.7
Long-term policy benchmark
19.7
9.9
7.3
1.8
–0.4
–0.6
Total assets excl. property
20.8
9.8
6.8
Long-term policy benchmark
19.2
9.8
7.3
1.6
0.0
-0.5
Value added
Value added
34
Annual Report 2016/17
bartscharity.org.uk
Future plans
Reserves and risks
Areas of particular focus for FY2017/18 are: to expand our grant-giving to deliver transformational change in healthcare and to support the longer-term vision of both Barts Health and Barts and The London School of Medicine and Dentistry (SMD);
Our reserves, spending and long-term investment policies are intended to deliver the following objectives: to provide for long-term stability and liquidity, sufficient for the funding of grant-making and operating activities;
to grow the major gifts fundraising programme with the aim of significantly increasing income; to raise the Charity’s profile and influence across the five hospitals of Barts Health through implementation of Barts Charity hubs in St Bartholomew’s Hospital and The Royal London Hospital, and through greater engagement with Barts Health staff, patients and their families; to expand engagement with and increase donations to our trauma appeal; to promote the Charity as a major funder of world-class medical research; to continue development of the website with a view to increasing online engagement with all stakeholders; and to enhance operational efficiency through effective use of IT solutions and an expanded staff development programme.
bartscharity.org.uk
Reserves policy
to maintain the ‘real’ purchasing power of the reserves such that Barts Charity can exist in perpetuity; to confirm annually the minimum level to which Barts Charity could expect reserves to fall temporarily in the worst case as a result of exceptional grants and/or market movements; to agree actions to rebuild the levels of reserves if the minimum is not achieved; and to review and update the reserve, spending and long-term investment policies on an annual basis.
The management of risk
Our Trustees regularly review the major risks to which Barts Charity is exposed. An operational risk register is reviewed and updated annually as part of the annual business planning process, while a strategic risk register is reviewed by Trustees at all Board and Committee meetings. Where appropriate, systems and procedures have been established to mitigate risks, and these are also reviewed regularly. The major risks include the ability to sustain the current level of income, a fall in investment values and returns, reputational risk, and unforeseen changes in the NHS. These risks are mitigated by careful portfolio construction, active management and review of investments, and regular liaison with the management teams of Barts Health and SMD.
Donations and grants Donations and grants
(greater than £50,000) Boston Scientific
The Cadogan Charity South Essex Partnership NHS Foundation Trust Family of J G T Forbes Marie Celeste Samaritan Society plus one anonymous donation
Legacies Legacies £5,000 and over W Allum R Cattini E Dickens D Fieldwick M Frost M Hammond J Herbert F Janes P Johnston E May B Parker I Shand T Smith A Testro W Verral A Weston B White
Annual Report 2016/17
35
Accounts Financial statements for 2016/2017 Statement of Trustees’ responsibilities
36
Auditor’s report
37
Financial statements and notes to the accounts
38
Statement of Trustees’ responsibilities in respect of the Trustees’ Annual Report and the financial statements The Trustees are responsible for preparing the Trustees’ Annual Report and the financial statements in accordance with applicable law and regulations. Company law requires the Trustees to prepare financial statements for each financial year. Under that law, they are required to prepare the financial statements in accordance with UK Accounting Standards and applicable law (UK Generally Accepted Accounting Practice), including FRS 102, the Financial Reporting Standard applicable in the UK and Republic of Ireland. 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 excess of income over expenditure for that period. In preparing these financial statements, the Trustees are required to: Select suitable accounting policies and then apply them consistently; Make judgements and estimates that are reasonable and prudent; State whether applicable UK Accounting Standards have been followed, subject to any material departures disclosed and explained in the financial statements; and Prepare the financial statements on a going concern basis unless it is inappropriate to presume that the charitable company will continue its activities. The Trustees are responsible for keeping adequate accounting records that are sufficient to show and explain the charitable company’s transactions and disclose with reasonable accuracy at any time the financial position of the charitable company and enable them to ensure that the financial statements comply with the Companies Act 2006. They have general responsibility for taking such steps as are reasonably open to them to safeguard the assets of the charitable company and to prevent and detect fraud and other irregularities. The Trustees are responsible for the maintenance and integrity of the corporate and financial information included on the charitable company’s website. Legislation in the UK governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions. Signed on behalf of the Trustees of Barts Charity.
Chairman 19 July 2017
36
Annual Report 2016/17
bartscharity.org.uk
Independent auditor’s report to the members of Barts Charity We have audited the financial statements of Barts Charity for the year ended 31 March 2017 set out on pages 38–52. The financial reporting framework that has been applied in their preparation is applicable law and UK Accounting Standards (UK Generally Accepted Accounting Practice), including FRS 102, the Financial Reporting Standard applicable in the UK and Republic of Ireland. This report is made solely to the charitable company’s members, as a body, in accordance with Chapter 3 of Part 16 of the Companies Act 2006. Our audit work has been undertaken so that we might state to the charitable company’s members those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the charitable company and its members as a body, for our audit work, for this report, or for the opinions we have formed. Respective responsibilities of Trustees and auditor As explained more fully in the Statement of Trustees’ Responsibilities set out on page 36, the Trustees (who are also the directors of the charitable company for the purposes of company law) are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view. Our responsibility is to audit, and express an opinion on, the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors.
bartscharity.org.uk
Scope of the audit of the financial statements A description of the scope of an audit of financial statements is provided on the Financial Reporting Council’s website at http://www.frc.org.uk/ auditscopeukprivate. Opinion on financial statements
In our opinion the financial statements: give a true and fair view of the state of the charitable company’s affairs as at 31 March 2017 and of its incoming resources and application of resources, including its income and expenditure, for the year then ended; have been properly prepared in accordance with UK Generally Accepted Accounting Practice; and
Matters on which we are required to report by exception We have nothing to report in respect of the following matters where the Companies Act 2006 requires us to report to you if, in our opinion: the charitable company has not kept adequate accounting records or returns adequate for our audit have not been received from branches not visited by us; or the financial statements are not in agreement with the accounting records and returns; or certain disclosures of Trustees’ remuneration specified by law are not made; or we have not received all the information and explanations we require for our audit.
have been prepared in accordance with the Companies Act 2006. Opinion on other matters prescribed by the Companies Act 2006 In our opinion the information in the Trustees’ Annual Report, which constitutes the Directors’ Report, for the financial year is consistent with the financial statements. Based solely on the work required to be undertaken in the course of the audit of the financial statements and from reading the Directors’ Report: we have not identified material misstatements in that report; and
Fleur Nieboer (Senior Statutory Auditor) For and on behalf of KPMG LLP, Statutory Auditor Chartered Accountants 15 Canada Square London E14 5GL 9 August 2017
in our opinion, that report has been prepared in accordance with the Companies Act 2006.
Annual Report 2016/17
37
Accounts Statement of Financial Activities (including income and expenditure account) for the year ended 31 March 2017
Notes Unrestricted Restricted Endowment funds funds funds £000 £000 £000 Income Income from generated funds: Donations 73 1,170 0 Legacies 1,060 371 0 Grants and other voluntary income 0 986 0 Total income from generated funds 2 1,133 2,527 0 Income from investments 7.3 13,024 691 0 Total income 14,157 3,218 0 Expenditure Costs of generating funds: Voluntary fundraising costs Investment management costs: Financial Property Total cost of generating funds Charitable activities Total expenditure
Annual Report 2016/17
2016 Total funds £000
1,243 1,431 986 3,660 13,715 17,375
1,303 660 405 2,368 11,678 14,046
867
25
0
892
762
1,700 783 3,350
0 0 25
0 0 0
1,700 783 3,375
1,557 540 2,859
3.1
9,724 13,074
3,018 3,043
0 0
12,742 16,117
25,744 28,603
18,501
422
39,316
58,239
22,513
19,584
597
39,316
59,497
7,956
91,322
19,630
251,263
362,215
354,259
110,906
20,227
290,579
421,712
362,215
During the year, no operations have been either discontinued or acquired by Barts Charity. The notes on pages 41–52 form part of these accounts.
38
2017 Total funds £000
Net gains/losses on investments Gains/(losses) on revaluation and disposal of investment assets Net income/(expenditure) and net movement in funds Reconciliation of funds Fund balances brought forward at 31 March 2016 Fund balances carried forward at 31 March 2017
bartscharity.org.uk
Balance Sheet as at 31 March 2017 2017 Notes Unrestricted Restricted Endowment Total funds funds funds funds £000 £000 £000 £000
2016 Total funds £000
Fixed assets Intangible and tangible assets Heritage assets Investments Total fixed assets
5 6 7.1
154 0 139,704 139,858
0 0 23,720 23,720
0 14,428 276,151 290,579
154 14,428 439,575 454,157
244 14,428 383,336 398,008
Current assets Debtors Cash at bank and in hand Total current assets
8.1
4,564 985 5,549
160 0 160
0 0 0
4,724 985 5,709
3,794 103 3,897
Creditors: amounts falling due within one year
9.1
(18,528)
(2,973)
0
(21,501)
(25,505)
Net current (liabilities)/assets
(12,979)
(2,813)
0
(15,792)
(21,608)
Total assets less current liabilities Creditors: amounts falling due after more than one year
126,879
20,907
290,579
9.2
(15,973)
(680)
0
110,906
20,227
290,579
421,712
362,215
Funds of Barts Charity Capital funds: Endowment funds
10.1
0
0
290,579
290,579
251,263
Income funds: Restricted funds
10.2
0
20,227
0
20,227
19,630
Unrestricted funds General funds Designated funds
10.3
110,099 807
0 0
0 0
110,099 807
90,403 919
110,906
20,227
290,579
421,712
362,215
Total net assets
Total funds
438,365 (16,653)
376,400 (14,185)
The notes on pages 41–52 form part of these accounts.
Paul Rawlinson Chairman 19 July 2017
bartscharity.org.uk
William Medlicott Trustee
Annual Report 2016/17
39
Accounts Cash Flow Statement for the year ended 31 March 2017
Notes 2017 £000
2016 £000
Cash flows from operating activities Net cash used in operating activities
11.1
(14,764)
(2,134)
13,669 (19) (41,693) 43,689 0 15,646
11,150 (197) (87,860) 66,840 (104) (10,171)
Change in cash and cash equivalents in the reporting year
882
(12,305)
Cash and cash equivalents at the beginning of reporting year
103
12,408
985
103
Cash flows from investing activities Dividends, interest and rents from investments Payments to acquire intangible fixed assets Payments to acquire investment assets Receipts from sales of investment assets Receipt/(payments) from prior year investment property transactions Net cash provided by (used in) investing activities
Cash and cash equivalents at the end of reporting year
The notes on pages 41–52 form part of these accounts.
40
Annual Report 2016/17
bartscharity.org.uk
Notes to the accounts 1 Accounting policies 1.1 Accounting convention The financial statements have been prepared under the historic cost convention, with the exception of investments and heritage assets, which are included at year-end market value. The financial statements have been prepared in accordance with the Statement of Recommended Practice: Accounting and Reporting by Charities (Charities SORP [FRS 102]), the Financial Reporting Standards 102 applicable in the UK and Republic of Ireland (FRS 102), the Charities Act 2011 and UK Generally Accepted Accounting Practice as it applies from 1 January 2015. The financial statements have been prepared to give a ‘true and fair’ view and have departed from the Charities (Accounts and Reports) Regulations 2008 only to the extent 1.3 to provide a true and fair view. This departure has involved following the Charities SORP (FRS 102) issued on 16 July 2014 rather than the preceding Charities SORP (SORP 2005) which was effective from 1 April 2005 and has since been withdrawn. Barts Charity constitutes a public benefit entity as defined by FRS 102. 1.2 Transfer of assets and legal separation Barts Charity is a charitable company limited by guarantee, regulated solely by the Charity Commission. Before 31 July 2014, it was known as Barts and The London Charity Trustee and was regulated by both the Charity Commission and the Secretary of State for Health, under the powers set out in the NHS Act 2006. Under an appointment by the NHS Trust Development Authority effective 1 April 2013, it acted as the trustee of the unincorporated charity, Barts and The London Charity. By a Deed of Assignment effective midnight 30 July 2014, Barts and The London Charity Trustee transferred all of the assets which it held in its capacity as trustee (save as set out
bartscharity.org.uk
below) to itself as absolute owner. The Charity Commission approved this assignment in an Order dated 28 July 2014. By a Statutory Instrument dated 31 July 2014 (2014 No. 1905), Barts and The London Charity Trustee ceased to be regulated by the Secretary of State for Health under the provisions of the NHS Act 2006. Barts and The London Charity Trustee also changed its name to Barts Charity with effect from the same date. By virtue of a Charity Commission Order dated 31 July 2014, Barts Charity was appointed as trustee of the permanent endowment assets remaining in Barts and The London Charity and the four Special Purpose Charities related thereto. By a Charity Commission uniting direction dated 31 July 2014, Barts Charity is permitted to account for these trustee assets within its accounts. Fund structure a. Restricted funds are funds for which a legal restriction exists over their use and related income is restricted to the purpose of the fund as set out in note 10.2. b. Endowment funds include the following: (i) Permanent endowment funds: capital is held in perpetuity but the related income may be used for unrestricted or restricted purposes as specified by the donor. (ii) Expendable endowment: donations received by the hospitals of Barts Health NHS Trust prior to 5 July 1948 (the date on which the NHS was established). The income and capital are available for such expenditure related to sections 220(3) and 220(5) and paragraph 10(1) of Schedule 4 of the National Health Service Act 2006 (see c(i) below). c. Unrestricted funds and their related income are available for use at the discretion of the Trustees for general charitable purposes relating to the following:
(i) General Sections 220(3) and 220(5) and paragraph 10(1) of Schedule 4 of the National Health Service Act 2006: To hold the property on trust for such purposes relating to hospital services (including research), or to any other part of the health service associated with any hospital, as the person holding the property thinks fit. (ii) Designated The Trustees have chosen to earmark these funds for specific areas within the general charitable purposes (see note 10.3). 1.4 Income Income is recognised when Barts Charity has entitlement to the funds, any performance conditions attached to the item(s) of income have been met, it is probable that the income will be received and the amount can be measured reliably. For legacies, entitlement is taken as the earlier of the dates on which either: Barts Charity is aware that probate has been granted, the estate has been finalised and notification has been made by the executor(s) to Barts Charity that a distribution will be made, or when a distribution is received from the estate. Receipt of a legacy, in whole or in part, is only considered probable when the amount can be measured reliably and Barts Charity has been notified of the executor’s intention to make a distribution. Where legacies have been notified to Barts Charity, or it is aware of the granting of probate, and the criteria for income recognition have not been met, then the legacy is treated as a contingent asset and disclosed if material. Rental income from investment properties is reported as an operating lease and the lease incentive is amortised on a straight-line basis.
Annual Report 2016/17
41
Accounts Notes to the accounts 1.5 Expenditure All expenditure is accounted for on an accrual basis. Direct costs of generating funds (including fundraising), charitable activities and support costs are charged to the relevant category or activity according to the area to which the expenditure relates. Support and governance costs incurred that relate to more than one cost category are apportioned based on estimates of time spent on activity in each area. Charitable activities include grants approved by the Trustees during the year, and are recognised as commitments in the year of approval. 1.6 Fixed assets a. Tangible and intangible assets Tangible and intangible assets are included in the balance sheet at cost less accumulated depreciation. Depreciation is charged on a straight-line basis to support costs over the estimated useful life of three years for software development costs and five years for other assets. See note 1.5 for apportionment basis. b. Heritage assets Heritage assets are capitalised and include art collections, historic archives, sculptures, ceramics, surgical instruments, uniforms, teaching materials and other items. They are reported on the balance sheet at their insured values, which are based on replacement values in the retail market or, where appropriate, in the second-hand retail market with items of a similar nature, age, condition and quality. They are not depreciated but are revalued every five years with the last valuation completed by Gurr Johns, auctioneers and valuers, in March 2014. Any surplus or deficit on revaluation is credited or debited to the Statement of Financial Activities.
42
Annual Report 2016/17
Assets are reviewed regularly for significant damage and appropriate remedial works are carried out wherever possible to preserve the assets or prevent further deterioration. See note 6 for further details. c. Investments Quoted investments are stated at market value at the balance sheet date. Asset purchases and sales are recognised at date of trade. Unquoted pooled financial investments are stated at fair value, the basis of fair value being the market value of the underlying investments held. These valuations are provided by the fund managers and are subject either to independent valuation or annual audit. Private investments are held through funds managed by private investment groups. As there is no identifiable market price for private investment funds, these funds are included at the most recent valuations from the private investment groups and adjusted for cash flows if the valuation is not available at the balance sheet date. The annual market valuation of Barts Charity’s investment properties has been carried out in accordance with the Royal Institution of Chartered Surveyors Valuation – Professional Standards (January 2014). The valuations were carried out by Gerald Eve LLP, Chartered Surveyors, who have been instructed as external valuer to value Barts Charity’s freehold and long leasehold interests at 31 March 2017. They have reported their opinion of the aggregate of the values of Barts Charity’s interest in the individual buildings.
1.7 Realised and unrealised gains and losses Realised and unrealised gains and losses on investment assets are included in ‘gains and losses on investment assets’ within the Statement of Financial Activities. 1.8 Overdraft facility An overdraft facility permitted under charity law and supported by Bart’s Charity’s Memorandum and Articles of Association was renewed in July 2016. It is used for short-term cash flow requirements while also allowing Barts Charity to be fully invested. 1.9 Financial instruments Basic financial instruments are initially recognised at their transaction value and subsequently measured at their fair value as at the balance sheet date using the closing quoted market price. The Statement of Financial Activities includes the net gains and losses arising on revaluation and disposals throughout the year. Barts Charity does not acquire put options, derivatives or other complex financial instruments.
bartscharity.org.uk
1.10 Pensions contributions The cost of employer contributions to the NHS Pension Scheme and the Defined Contribution Scheme is charged to the Statement of Financial Activities. Certain past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of benefits payable under these provisions can be found on the NHS Pensions website (www. pensions.nhsbsa.nhs.uk). The Scheme is an unfunded, defined benefit scheme,
preparing its own statements, that covers NHS employers, general practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The Scheme is not designed to be run in a way that would enable NHS bodies to identify their share of underlying Scheme assets and liabilities. Therefore, the Scheme is accounted for as if it were a defined contributions scheme: the cost to an NHS body of participating in the Scheme is taken as equal to the contributions payable to the Scheme.
Applicable rates for employee contributions for the NHS Pension Scheme ranged from 12.5% to 13.5% for 2016/17 and from 9.3% to 13.5% for 2015/16, while employer contributions were 14.3% for both 2016/17 and 2015/16. Employees employed after 1 April 2011 can choose to belong to a Defined Contribution Scheme, which is a Group Personal Pension Scheme. For 2016/17, the rates of employer contribution for the Defined Contribution Scheme were 9% for directors and 7% for other staff. Employee contributions are voluntary.
Details of 2 income from generated funds 2017 Unrestricted Restricted Endowment Total funds funds funds funds £000 £000 £000 £000
2016 Total funds £000
Donations Legacies Grants and other voluntary income Total 2017
73 1,060 0 1,133
1,170 371 986 2,527
0 0 0 0
1,243 1,431 986 3,660
1,303 660 405 2,368
Total 2016
420
1,948
0
2,368
bartscharity.org.uk
Grants and other voluntary income includes £620,777 transfer of funds from the South Essex Partnership Foundation Trust for the benefit of the patients and staff of the Bedford and Luton Services of the East London Foundation Trust. This has been reported as restricted funds.
Annual Report 2016/17
43
Accounts Notes to the accounts Details of 3.1 Grant- Activities funded undertaken resources activity directly expended – £000 £000 charitable activities by funding source Research 8,452 16 Enhancement in service delivery 2,523 114 Innovation and training 35 367 Patient and community engagement 141 56 Others 0 456 Total 11,151 1,009 Reversal of prior years’ grants (a) (492) 0 Total after reversal of prior years’ grants 10,659 1,009 Total for 2016 23,898 796
2017 Total funds £000
2016 Total funds £000
659 221 84 23 87 1,074 0
9,127 2,858 486 220 543 13,234 (492)
15,108 10,252 467 388 309 26,524 (780)
1,074
12,742
25,744
1,050
25,744
(a) Reversal of prior years’ grants reflects underspend across various projects. Although Barts Charity maintains regular contact with grantholders, there are occasions when planned expenditure is not achievable and the related grant accrual is reversed.
Direct charitable 3.2 expenditure by institution
2017 Aggregate amount paid £000
2016 Aggregate amount paid £000
3,005 7,688 (34) 10,659 1,009 11,668
11,855 11,959 84 23,898
Barts Health NHS Trust Barts and The London School of Medicine and Dentistry Other Grant-funded activity Activities undertaken directly for benefit of patients at Barts Health NHS Trust Total grants awarded
796 24,694
The £11.668m of grants awarded does not include Barts Charity staff and support costs allocated to charitable activities. A detailed list of grants paid to institutions during the year can be obtained on application to Barts Charity’s office at 12 Cock Lane, London EC1A 9BU.
Grants paid to individuals
3.3
No grants were paid to individuals in 2016/17 or 2015/16.
Auditor’s remuneration
3.4
In 2016/17, the external auditor was paid £50,280 (inclusive of VAT) in respect of the audit of statutory accounts (£50,280 in 2015/16). Additional costs for assurance services and tax advice for the financial year to March 2017 were £nil and £720, respectively (£34,800 and £20,680, respectively, in 2015/16).
44
Staff and support costs £000
Annual Report 2016/17
bartscharity.org.uk
Resources 3.5 Cost of generating funds expended, including Fundraising Investment management Charitable 2017 support costs Financial Property activity Total £000
£000
£000
£000
£000
2016 Total £000
85
1,562
625
11,668
13,940
26,657
Salary costs 534 95 Apportionment of other overheads 273 43 Total support costs 807 138 Total resources expended 2017 892 1,700 Direct costs 100 1,452 Salary costs 446 73 Apportionment of other overheads 216 32 Total support costs 662 105
108 50 158
733 341 1,074
1,470 707 2,177
1,306 640 1,946
783
12,742
16,117
28,603
411 88 41 129
24,694 699 351 1,050
26,657 1,306
Total resources expended 2016 762 1,557
540
25,744
Direct costs
640 1,946
28,603
Where possible, costs have been directly allocated to one of the above categories. Of total overheads, 69% were allocated in this manner for 2016/17 (69% in 2015/16). The remainder, relating to general office costs, has been allocated on the basis of staff time. Support costs include governance costs of £129,098 (£156,250 in 2015/16). Restricted expenditure amounted to £3.04m in 2016/17 (£2.62m in 2015/16).
Analysis of 4.1 2017 staff costs Total £000 Salaries and wages 1,239 Social security costs 139 Other pension costs 92 Total 1,470
Average monthly number of full-time equivalents Average head count
26 27
2016 Total £000 1,109 115 82 1,306 23 24
Staff costs include restructuring costs of £33,150 (£nil in 2015/16).
Pension 4.2 The following pension contributions were made for employees within the annual emolument ranges indicated: Value of Number contributions contributions of staff for higher paid £000 receiving employees £ contributions
bartscharity.org.uk
70,001 to 80,000 80,001 to 90,000 120,001 to 130,000
2 12 11
1 1 1
Annual Report 2016/17
45
Accounts Notes to the accounts Higher paid 4.3 The following number of employees received annual emoluments falling within the ranges indicated: employees £ 2017 2016 60,001 to 70,000 1 1 2 0 70,001 to 80,000 80,001 to 90,000 1 2 1 0 120,001 to 130,000 140,001 to 150,000 0 1
Key management personnel (the senior management team of the charity) received aggregate employee benefits of £583,301 in 2016/17 (£443,677 in 2015/16).
assets Fixed 5 Fixed assets: Intangible and tangible
Fixtures, Intangible fittings and assets equipment £000 £000
Total
£000
Tangible and intangible fixed assets: Balance at 31 March 2016 Additions Write off Balance at 31 March 2017 Accumulated depreciation: Balance at 31 March 2016 Charge for the year Write off Balance at 31 March 2017 Net book value at: 31 March 2017
0 0 0 0 0 0 0 0
244 3 (8) 239 207 22 (8) 221
300 (1) (48) 251
544 2 (56) 490
93 70 (48) 115
300 92 (56) 336
0
18
136
154
31 March 2016
0
37
207
244
2017 £000
2016 £000
Valuation at start of year Revaluation Valuation at end of year
14,428 0 14,428
14,428 0 14,428
Type of heritage asset: Antique furniture Paintings, prints and drawings Books and manuscripts Other Total
2,165 5,631 2,897 3,735 14,428
Heritage assets
46
Freehold land and buildings £000
6
Annual Report 2016/17
Painting, prints and drawings include two William Hogarth paintings which have been valued at £1.4m and £1.25m. Other heritage assets include clocks, barometers, works of art, sculptures, ceramics, glass, silver and gold (see note 1.6b). Heritage assets were presented on the balance sheet under unrestricted funds as at 31 March 2016; this was a presentation error and does not impact on any brought forward balances.
bartscharity.org.uk
Analysis Property Financial of 7.1 Fixed asset investments fixed asset investments £000 £000 Market value at 1 April 2016 125,480 257,848 Less: Disposals at carrying value 0 (42,996) Add: Acquisitions at cost 540 41,150 Net gain/(loss) on revaluation 9,810 47,247 Market value at 31 March 2017 135,830 303,249
Cash held as part of the investment portfolio Total
0 135,830
496 303,745
Investments 7.2 Market value at 31 March:
Investment properties Investments listed on stock exchange Cash held as part of the investment portfolio Alternative investments Total
bartscharity.org.uk
2016 Total
£000
£000
383,328 (42,996) 41,690 57,057 439,079
339,646 (66,174) 87,852 22,004 383,328
496 439,575
8 383,336
2017 Total £000
2016 Total £000
135,830 276,146 496 27,103 439,575
125,480 234,790 8 23,058 383,336
‘Investment properties’ includes a property valued at £2.3m that was sold at auction on 30 March 2017, with completion taking place on 10 May 2017. This is reported as an event after the end of the reporting period under note 12. Financial investments held at 31 March 2017 include 16 unit trust funds, representing 91% of the total value, and 14 separate alternative investments.
Analysis of 7.3 gross income from investments Investment properties Investments listed on stock exchange Interest on cash held as part of the investment portfolio Total
2017 Total
2017 Total £000
2016 Total £000
6,009 7,698
5,083 6,541
8 13,715
54 11,678
Accounting for lease incentives increased investment property income by £161,000 in 2016/17 (£558,000 in 2015/16); see note 1.4. Restricted investment income amounted to £691,000 in 2016/17 (£657,000 in 2015/16).
Annual Report 2016/17
47
Accounts Notes to the accounts Analysis of 8.1 Amounts falling due within one year as at 31 March: debtors
2016 £000
Trade debtors 995 1,492 154 150 Prepayments Accrued income 3,369 2,144 Other debtors 206 8 4,724 3,794 Total Accrued income relates to income on financial investments and amortisation of rent-free period for related leases (see note 1.4). ‘Other debtors’ includes a £198,080 property sale deposit held by Barts Charity solicitors pending completion on 10 May 2017 (see notes 9.1 and 12).
2017 £000
8.2
Operating lease Barts Charity generates income from leasing out space within its investment properties. The future minimum lease payments under non-cancellable operating leases are as follows:
2017 £000 Not later than one year 5,569 Later than one year and not later than five years 18,887 Later than five years 30,399 54,855 Total Future minimum lease payments include £26.6m from a 45-year lease, granted in December 2014.
Analysis of creditors
9.1
5,397 15,671 29,103 50,171
2017 £000
2016 £000
1,291 433 18,449 1,328 21,501
1,308 175 22,774 1,248 25,505
Trade creditors Other creditors Grant accruals Deferred income Total
Deferred income represents rent billed to the tenants in advance for the first quarter of the following financial year. Prior period deferrals were released in FY2016/17. ‘Other creditors’ includes a property sale deposit of £198,080 held by Barts Charity solicitors pending completion on 10 May 2017 (see notes 8.1 and 12).
9.2
48
Amounts falling due within one year as at 31 March:
2016 £000
Annual Report 2016/17
Total creditors falling due after more than one year as at 31 March: Grant accruals Total
2017 £000
2016 £000
16,653 16,653
14,185 14,185
There are no grants payable whose values require subjective estimation and therefore no provisions have been included in this set of accounts.
bartscharity.org.uk
Analysis of 10.1 Endowment funds funds
Expendable endowments Permanent endowments: H F Bailey Aylwen Bursaries Edward Hewlett JJ Guthrie Blandford and George Shuter Staff Benefit Hannington David Hughes Bailey City and Hackney Hamblen Thomas MacCready Mann Levy Family 10 Funds each under £200k Total
Balance 31 March 2016 £000
Gains and losses £000
237,749 5,610 2,034 1,671 1,470 658 489 207 206 202 175 792 251,263
36,542 1,152 418 343 302 135 101 42 41 42 36 162 39,316
Balance 31 March 2017 £000 274,291 6,762 2,452 2,014 1,772 793 590 249 247 244 211 954 290,579
Note 1.3 on page 41 provides further details of the endowment fund structure. There were no other resources received, expended or transferred in FY2016/17. Investment gains on endowment funds amounted to £39.3m for FY2016/17 (gains of £13.5m in FY2015/16).
bartscharity.org.uk
Name of fund
Nature and purpose of each fund
Expendable endowments Permanent endowments: H F Bailey Aylwen Bursaries Edward Hewlett JJ Guthrie Blandford and George Shuter Staff Benefit Hannington David Hughes Bailey City and Hackney Hamblen Thomas MacCready Mann Levy Family
For purposes relating to NHS hospitals For children’s services Funding of research bursaries General purposes Staff benefit General purposes General purposes For children’s services For children’s services Research purposes General purposes, Royal London Hospital
Annual Report 2016/17
49
Accounts Notes to the accounts 10.2 Restricted funds Balance Incoming Resources Gains Balance 31 March resources expended and 31 March 2016 losses 2017 £000 £000 £000 £000 £000 Material funds JJ Guthrie Blandford and George Shuter Staff Benefit 1,563 63 3 390 2,019 Margaret Centre 1,226 46 (55) 0 1,217 Tallerman Research Fund Legacy 1,021 13 (226) 0 808 Gastroenterology Whipps Cross 629 7 0 0 636 Renal Disease Research 536 9 (26) 0 519 Funds £400k–£500k (1) 256 282 (62) 0 476 Funds £300k–£400k (6) 1,917 585 (434) 0 2,068 Funds £200k–£300k (8) 2,057 215 (200) 0 2,072 Funds £100k–£200k (25) 2,769 531 (35) 24 3,289 Others (605) 7,656 1,467 (2,008) 8 7,123 Total 19,630 3,218 (3,043) 422 20,227 Note 1.3 on page 41 provides further details of the restricted fund structure. Investment gains on restricted funds amounted to £422,000 in FY2016/17 (losses of £32,000 in FY2015/16).
JJ Guthrie Blandford and George Shuter Staff Benefit Margaret Centre Tallerman Research Fund Legacy Gastroenterology Whipps Cross Renal Disease Research
Nature and purpose of each fund Staff benefit Margaret Centre at Whipps Cross University Hospital Facilitates research into children’s diseases Gastroenterology department at Whipps Cross Renal research
10.3 Designated funds
Balance 31 March 2016 £000
Incoming resources £000
Material funds Whipps Cross general fund HF Bailey City and Hackney Cardiac fund Funds up to £100k (9) Total
214 157 122 426 919
0 0 0 0 0
50
Details of material funds Name of fund
Resources Balance expended 31 March 2017 £000 £000 (32) 0 0 (80) (112)
182 157 122 346 807
Details of material funds Name of fund
Nature and purpose of each fund
Whipps Cross general fund HF Bailey City and Hackney Cardiac fund
Hospital services at Whipps Cross University Hospital East London NHS Foundation Trust Treatment of and research into cardiac disease
Annual Report 2016/17
bartscharity.org.uk
Notes to 11.1 Net cash used in operating activities the Cash Flow Statement Net income/(expenditure) for the period Adjustments for: Gains/losses on revaluation and disposal of investment assets Receipt from prior year property transaction Investment income Depreciation charges (Increase)/decrease in debtors (Decrease)/increase in creditors Cash (outflow)/inflow from operating activities
2017 £000
2016 £000
59,497
7,956
(58,239) 0 (13,715) 92 (805) (1,594) (14,764)
(22,617) 104 (11,677) 100 5,326 18,674 (2,134)
11.2 Analysis of changes in cash and cash equivalents Balance Movement 2016 £000 £000 after the 12 Events end of the reporting period Trustee and connected persons transactions
Cash in hand and at bank Total cash and cash equivalents
103 103
882 882
Balance 2017 £000 985 985
An investment property was sold at auction on 30 March 2017 for £2.45m and a deposit of £198,080 was held by Barts Charity solicitors (see notes 8.1 and 9.1). Completion took place on 10 May 2017 so legal ownership remained with Barts Charity at 31 March 2017 and the property is included within investments (note 7.1).
13.1
Trustee expenses reimbursed Trustee expenses of £550 for hospitality were reimbursed in 2016/17 to two Trustees (£5,116 to one Trustee in 2015/16).
13.2
Trustee remuneration No Trustee received remuneration in 2016/17 or 2015/16.
13.3 Details of transactions with Trustees or connected persons There were no other transactions with the Trustees or connected persons in 2016/17 or 2015/16. 13.4 Trustee indemnity insurance Year ended Year ended 31 March 2017 31 March 2016 £ £ Premiums paid by Barts Charity during the reporting period 1,259 1,219
bartscharity.org.uk
Annual Report 2016/17
51
Accounts Notes to the accounts Loans or 14 guarantees secured against assets Connected 15 organisations
There were no such loans or guarantees for Barts Charity in 2016/17 or 2015/16.
Related party transactions
During the year, neither the Trustees, nor any member of the key management staff or parties related to them, undertook any material transactions with Barts Charity.
16
There were no connected organisations of Barts Charity in 2016/17 or 2015/16.
The total amount of related party transactions made without conditions was £5,000 (£nil in 2015/16). During the year, Barts Charity made revenue and capital grants totalling £3.0m and £7.7m to Barts Health NHS Trust and Barts and The London School of Medicine and Dentistry, respectively. Ian Peters is a Trustee and Chairman of Barts Health NHS Trust.
52
Annual Report 2016/17
bartscharity.org.uk
Support Barts Charity
4
There are many ways in which you can help, either as an individual or organisation:
6
Become a long-term partner, working closely with our clinicians and scientists Introduce us to contacts who could help support our work Organise or take part in a fundraising event
Leave a gift in your will
8
10
Support us with a regular gift or a one-off donation
For further information about how you can get involved and support our beneficiaries, contact our fundraising team
 on 020 7618 1720 or go to www.bartscharity.org.uk.
Photography: Cover, inside front cover (upper two images), pp. 1 (centre two images), 2 (lower), 3, 4, 6, 7, 9 (upper right), 12, 14, 15, 16 (lower), 17, 18, 19, 20, 21, 23 (upper), 25, 26, 27, 28, 29: Noel Murphy; inside front cover (Blizard Institute): Morley von Sternberg; inside front cover (lower): Vitae Photography; pp. 1 (upper), 2, 22 (upper): Ian Jones; pp. 1, 24, 32: Stephen Hawking School; p. 5 (Hackney): Walej/ Wikimedia Commons; p. 5 (Waltham Forest): Leyton59/Wikimedia Commons; p. 5 (Redbridge): Sunil060902/Wikimedia Commons; p. 5 (Tower Hamlets): Noel Murphy; p. 5 (Newham): Ewan Munro/Wikimedia Commons; p. 5 (Barking): Diamond Geezer/Flickr; p. 6 (Mile End Hospital): Barts Health NHS Trust; p. 8 (upper): Blizard Institute; p. 8 (lower): Morley von Sternberg; p. 9 (upper left, centre right): Barts Research Centre for Women’s Health); p. 9 (centre): Dr Varun Sethi; p. 9 (lower): Dr Suchita Nadkarni; p. 10: Vitae Photography; p. 11 (top right): courtesy CME; p. 11 (bottom right): courtesy Bank of Montreal; p. 13 (right): courtesy Dr James Whiteford; p. 16: Dr Mohammad Taghi Niknejad, Radiopaedia.org, rID: 20472; p. 20: courtesy Alison Thomson; pp. 21 (top), 31: courtesy Dr John Conibear; p. 22 (deer and crow): Dolores Mateo; p. 22 (robin): Colin Page. Text and project management: Ian Jones, Jinja Publishing Ltd. Design and production: Fountainhead Creative Consultants.
Barts Charity
Ground Floor, 12 Cock Lane London EC1A 9BU Tel: 020 7618 1717 Fax: 020 7248 9395 Web: www.bartscharity.org.uk Barts Charity is a charity registered in England and Wales, no. 212563, and a company registered in England and Wales, no. 7168381, whose registered office is 12 Cock Lane, London EC1A 9BU.