Annual Report 2018
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 2018
Barts Charity
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Support Barts Charity There are many ways in which you can help, either as an individual or organisation:
Support us with a regular gift or a one-off donation 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
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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, pp. 1, 2 (lower), 3, 4, 6, 7, 8 (upper left), 9, 10, 11, 12, 13, 14, 16, 17, 18 (lower), 20, 21, 22, 23, 24, 25 (lower), 28, 29, 31, 32: Noel Murphy; pp 1 (right, centre), 8, 15 (top right): Barts and The London School of Medicine and Dentistry; p. 2 (upper): Ian Jones; p. 5: iStock/Getty Images; p. 18 (upper): Shutterstock; p. 25: iStock/Getty Images; p. 27 (upper): courtesy Aspen UK.
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Text and project management: Ian Jones, Jinja Publishing Ltd. Design and production: Fountainhead Creative Consultants.
Contents Chairman’s report
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Barts Charity: A year in numbers
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Our communities and partners
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Our partners: Barts Health Barts and The London School of Medicine and Dentistry
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Our grants Robotic surgery Children and women’s health Cancer care Trauma care A learning health system Sickle cell disease treatment Respiratory health Diabetic kidney disease care Brain surgery Preventing liver disease
14 16 18 18 20 22 23 24
Our supporters
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Governance Governance review Professional advisers Trustees and Board Advisers
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18 28 29
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Finance review and strategic report Financial review Financial statements Auditor’s report Statement of Trustees’ responsibilities Financial statements and notes to the accounts
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bartscharity.org.uk
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Annual Report 2017/18
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Chairman’s report
A year ago I reported that Barts Charity had set itself the challenging target of awarding £30m in grants in each of the next three years – a threefold increase from our previous annual programme. I am delighted to say that we have succeeded in our first year, granting £30m to healthcare innovation projects. More important than the headline number, however, is the high quality of the projects we have funded and the pipeline we have built. I have been impressed by the range of major projects, some of which are described in this report. These include a capital project at Whipps Cross University Hospital designed to benefit 5,000 women and their families a year, purchase of surgical robots, and funding of a healthcare data project, alongside major investments into research in cancer and liver disease. It was also our aim to be more agile, so that we could respond more promptly to the funding needs of our partners – Barts Health NHS
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Trust (Barts Health) and Barts and The London School of Medicine and Dentistry (SMD). I am pleased to say we have delivered this. By way of example, the surgical robots project took less than a year to go from the original idea through the grants application process, award, purchase of equipment and clinical training to being used for ground-breaking surgery and better research data. I am delighted to say that they have already been used in multiple procedures which are the first of their kind in the UK. I must pay tribute to the commitment of Trustees and staff who have coped with the additional demands that the expanded grants programme has brought. Not only have we increased the size of our programme, but we have also enhanced our grant application and monitoring procedures to ensure they deliver the planned benefits for research and patient care. Looking ahead, our ambition is to maintain the volume and quality of our funding into the future.
In 2017/18
our funding awards totalled:
We must address our income generation if we are to sustain higher levels of giving, and we have seen encouraging growth in our major gifts income this year. It is important that we build this income, as well as our fundraising in the community, if we are to sustain the transformational level of giving that is needed by Barts Health and SMD. Thanks to our ever-strengthening partnership with Barts Health and SMD, we have already identified a significant pipeline of potential funding projects that not only align closely with their strategic priorities but, most importantly, will help them to address some of the key healthcare challenges faced by the population of East London.
Paul Rawlinson Chairman
bartscharity.org.uk
£30m £15.6m £14.4m
Barts Health School of Medicine and Dentistry
for...
medical research equipment patient care projects enhancing environments
Over the last 5 years we have funded healthcare innovation totalling: £90.5m
…supporting joint strategic priority areas for the Charity, Barts Health and SMD:
…which would not otherwise have been supported by the NHS or other funders
cardiac cancer women and children trauma population health inflammatory disorders
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Our communities and partners
Population served by Barts Health
2.5m
Number of languages spoken in London
300
Percentage of London population living in poverty
21%
Benefiting the most disadvantaged Barts Health’s hospital and community services reach a population of 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.
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.
Difference in life expectancy in years between richest and poorest areas of London
15 years
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Improving healthcare delivery
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Generating funds Awarding grants
Strategic support: To maximise the impact of our funding we focus upon areas of excellence that reflect the joint strategic priorities of Barts Health and SMD (see page 3). Integrating research and clinical care: SMD research is tightly integrated with Barts Health services. This ensures that research addresses the key issues facing local populations, helps clinicians contribute to research, enables more patients to take part in studies, and provides a pathway for advances in research to feed rapidly into clinical practice.
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Local relevance, global impact: The ethnically diverse population that Barts Health serves has important implications for the nature of ill-health experienced and how it is treated. SMD research provides key insight into these issues to improve care for local people. But the ethnic diversity also means the findings of research are relevant to many other populations around the world.
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Building on excellence: Our funding goes to two of the UK’s leading healthcare institutions, enabling them to build upon nationally (sometimes internationally) renowned levels of care and worldleading research.
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We work closely with our partners, Barts Health NHS Trust and Barts and The London School of Medicine and Dentistry (SMD), to develop and fund projects that address the health needs of our communities. Our unique collaboration delivers outstanding developments in healthcare owing to a number of factors:
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Working with our partners
Groundbreaking medical research
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Catalytic funding: Our ‘pumppriming’ of research enables researchers to generate preliminary data to support funding applications to major funding bodies – bringing in millions of extra pounds for research. Furthermore, our funding enables Barts Health to pilot innovative models of care delivery, paving the way for their wider adoption in the NHS. Unrivalled population health data: North-East London benefits from a groundbreaking collaboration across Barts Health hospitals and local primary care, creating a shared data infrastructure going back 30 years and spanning 1.2 million people – a globally unique platform supporting research and improved patient care (see page 18).
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Our partners Barts Health NHS Trust
Every year, Barts Health, one of England’s largest NHS Trusts, delivers care to hundreds of thousands of patients. These include residents of East London and patients from elsewhere in the UK benefiting from its specialist services.
In 2017/18 we awarded £15.6m to Barts Health, providing state-ofthe-art equipment, supporting innovative new ways of delivering care, and enhancing hospital environments. Our funding is enabling Barts Health hospitals to stay at the forefront of healthcare innovation and ensuring patients benefit from the very latest technologies and ways of working. Across its five hospitals, Barts
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
Waltham Forest
Hackney Tower Hamlets
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
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bartscharity.org.uk
Barts Health at a glance... 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 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.
Provides care to some 2.5 million people in East London and beyond Treats more than 6,000 patients every day Turnover of £1.4bn Employs more than 16,000 people across five hospitals Recruits 32,000 patients a year into innovative clinical trials Nationally recognised expertise in multiple fields, including cardiac care, paediatrics, cancer, children’s orthopaedics and trauma
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
Undergoing a major redevelopment of its Women’s and Neonatal Unit with Barts Charity funding (see page 12)
Newham University Hospital
A busy district hospital providing a full range of services to local communities
Redbridge
Barking and Dagenham Newham
Particularly noted for its orthopaedic services Site of the Rainbow Centre for children and young people, completely transformed with Barts Charity funding
The Royal London Hospital
A major teaching hospital providing local and specialist services
Some of our most exciting, state-of-theart equipment, most innovative research and cutting-edge projects are funded by Barts Charity. I am hugely grateful for its role in helping us provide safe and compassionate care. Alwen Williams Chief Executive, Barts Health
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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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.
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 top medical school in London in the National Student Survey and third in Medicine nationally in the Guardian University Guide
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 Awarded major funding from Barts Charity in 2017/18 (see page 14)
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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 16), Barts Research Centre for Women’s Health (BARC; see page 12) and the newly funded Barts Liver Centre (see page 24)
bartscharity.org.uk
In 2017/18, we awarded ÂŁ14.4m in new grants to SMD, and at 31 March 2018 SMD researchers were undertaking 146 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 diverse make-up of East London populations provides a valuable resource for researchers. By participating in research,
Institute of Dentistry Ranked top dental school in UK for research in latest national research evaluation exercise Occupies state-of-the-art premises at The Royal London Dental Hospital, housing the most modern and technologically advanced equipment in the UK
local people are helping researchers understand how conditions affect particular groups, and how treatments can be better tailored to them. In addition, because of the diversity of local populations, findings are often of global relevance. 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.
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 Works closely with clinicians at St Bartholomew’s Hospital in the Barts Heart Centre, which has received major funding from Barts Charity
bartscharity.org.uk
I am immensely proud of our strong partnership with Barts Charity. Together, we have undertaken high-quality medical research which has led to improved healthcare nationally and globally, and addressed important health issues in some of the most vulnerable communities in East London. Prof. Steve Thornton Vice-Principal (Health) Queen Mary University of London
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 Barts Centre for Preventive Neurology, set up with Barts Charity funding
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Our grants This year, we have awarded £30m in support of innovative projects designed to transform patient care. The following pages highlight a selection of these new projects as well as some of the successes our previous funding has achieved during the year. Ms Elly Brockbank, Chair of the Robotic Users Group at The Royal London Hospital.
NEW FUNDING
Robots to the rescue
Patients at St Bartholomew’s Hospital and The Royal London Hospital are benefiting from groundbreaking robot-assisted surgery. With keyhole surgery, patients experience less pain and are back on their feet sooner. But it can be tricky to perform and cannot be used on all patients. Now, thanks to two new state-of-the-art robotic systems, Barts Health surgeons have been able to greatly expand their use of keyhole surgery. The robots each have four arms, to which can be attached a camera and surgical tools. These are controlled by a surgeon at a separate console, who gains an immersive three-dimensional view of the interior of the body. The tools are more flexible and manoeuverable than conventional keyhole instruments, making surgery easier to perform. Patients benefit in multiple ways. Robot-assisted surgery is quicker, so there is less likelihood of complications. In addition, patients experience less pain, and recover faster. Moreover, robot-assisted keyhole surgery can be performed on patients previously deemed unsuitable, including frail or overweight patients. At The Royal London Hospital,
the new robot is being shared by surgeons from six surgical disciplines to bring its benefits to as many different patient groups as possible. The breadth of use makes the programme unique in the NHS. The robot at St Bartholomew’s Hospital is dedicated to cardiothoracic surgery. Keyhole surgery in this area is particularly challenging, as surgeons need to enter the body through the ribcage and manipulate instruments on the side of the body. The new approach, predominantly used to treat lung cancer, has far less impact on patients, leaving them physically more able to cope with other aspects of their cancer treatment. Thanks to the recruitment of renowned robotic surgery specialists, and the growth in expertise among existing staff, the Hospital aims to establish the UK’s largest robotic cardiothoracic surgery centre.
At a glance…
The project: State-of-the-art robotic surgery equipment for The Royal London Hospital and St Bartholomew’s Hospital. What’s being done: Groundbreaking robotic technology is being introduced to extend and enhance the use of keyhole surgery. Impact: More patients are benefiting from keyhole surgery, experiencing less pain, fewer complications and quicker recovery.
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SUCCESS STORY
Sat nav surgery
It was great. If all the operations will be like this, all patients will be back on their feet the following day. Julie, 62, from Plaistow The first patient treated using robot-assisted surgery for a hysterectomy operation at The Royal London Hospital.
Barts Health surgeons have carried out a world-first lung cancer treatment, using virtual reality ‘sat nav’ equipment provided by Barts Charity. In February 2017, Anna SzotCzetowicz became the first patient to have lung tumour treatment guided by ‘navigational bronchoscopy’ – a technique that combines virtual reality with a kind of surgical sat nav. CT scans were used to provide a detailed picture of Anna’s lungs and the position of her tumour. These were used to plan a route through the many branches of the lung. During the procedure itself, surgeons overlaid this route onto a live CT image, to guide the positioning of a catheter with a tip capable of delivering high-energy microwave radiation to burn away cancerous tissue. Previously, to access the cancer, surgeons would have had to use invasive surgery and puncture the lung – a potentially dangerous procedure requiring an extended hospital stay. Remarkably, Anna was ready to go home the day after her operation. As well as avoiding painful and potentially risky surgery, the new approach could offer hope to the one in five patients who are currently unsuitable for existing treatment.
£5.1m
£145,000
2017
2014
Ms Elly Brockbank, Consultant Gynaecological Oncologist, and Mr Stephen Edmondson, Clinical Director, Cardiac and Thoracic Surgery
Mr Stephen Edmondson, Clinical Director, Cardiac and Thoracic Surgery
bartscharity.org.uk
If I wasn’t in hospital, I wouldn’t have known I’d had an operation. I feel physically and psychologically fantastic. Anna Szot-Czetowicz, 65, who underwent pioneering navigational bronchoscopy surgery to remove a lung tumour.
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Our grants
At a glance…
The project: Creating a centre of excellence for women and neonatal services at Whipps Cross Hospital. What’s being done: A total redevelopment of the Women’s and Neonatal Unit at Whipps Cross Hospital, including additional research space to involve more women in clinical trials.
NEW FUNDING
Impact: The redevelopment will create a modern, tranquil and welcoming environment that better matches the high quality of care currently provided.
Putting women and children first A remodelling of the Women’s and Neonatal Unit at Whipps Cross Hospital will create facilities that match the excellence of its care. Every month, 400 women give birth at Whipps Cross maternity unit. The forest of thank you cards pinned to the wall and a stream of appreciative emails testify to the high quality of care that women receive – as does the verdict of the Care Quality Commission (CQC), which rated Whipps Cross as the best maternity and gynaecology service in NorthEast London. These accomplishments are even more striking given the less than ideal space in which the service operates, charitably described by the CQC as ‘tired’. While parts of the unit have been upgraded in recent years, our new funding will enable it to remodel itself entirely – so that it can offer women, their partners and new babies the best possible experience. The grand redevelopment plan considers the entire journey of mums-to-be, from first antenatal appointment to birth itself and post-natal care. 12
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The key goal will be to make the experience as positive as possible for women throughout this journey. Birthing rooms will all have en-suite facilities, five will have birthing pools, and there will be facilities for partners to stay over. Particular attention will be given to the special care baby unit, where the current environment does not reflect the extremely high levels of care that premature and other poorly babies receive. A complete redesign will create a light and airy space, with more facilities for parents. Services will be moved around the building so that their arrangement is more logical, and access improved to the main hospital. More integrated links will be created to the neighbouring women’s health area. Another important goal is to create a dedicated space for women’s health research. This will enable Whipps Cross clinicians to recruit even more women into research studies, including those carried out under the umbrella of the Barts Research Centre for Women’s Health (BARC). Set up
with our funding in 2017, BARC has been awarded Collaborating Centre status by the World Health Organisation. Research will address some of the most important health problems affecting women and their unborn and newborn children. This expansion of research will create one of the largest centres for women’s health research in Europe. The Whipps Cross maternity unit is planning for increased demand and for additional complex deliveries. After it re-opens in 2020, an estimated 50,000 women will benefit from its unrivalled facilities over the following 10 years. £6.8m 2017 Dr Funlayo Odejinmi, Clinical Director for Women’s Health; Dr Reeba Oliver, Consultant Urogynaecologist; Deborah Twyman, Head of Midwifery and Gynaecology Services; and Kirsty Webb-Wood, General Manager, Women and Children’s Health bartscharity.org.uk
From left to right: Deborah Twyman, Dr Funlayo Odejinmi and Kirsty Webb-Wood.
Despite the poor condition of our estate, our staff deliver fabulous care. Our CQC rating is ‘good’, and after the capital investment, our goal is to be rated as ‘outstanding’. Kirsty Webb-Wood General Manager, Women and Children’s Health, Whipps Cross Hospital
A calming influence NEW FUNDING
It’s hard work and very stressful with special care babies but baby massage and baby yoga helped me. Momentarily I forgot about all the stress because Mikaeel was enjoying himself – the giggles and laughter are priceless.
‘Baby yoga’ sessions are de-stressing parents and helping them bond with their babies. Hospital stays can inevitably be stressful, but sessions organised by baby massage and yoga instructor Liz Thompson provide a muchappreciated time-out – a chance for relaxation, de-stressing and bonding with baby. Parents and babies not only feel better but recovery may be quicker too. Liz’s sessions focus on parents, helping them relax and building their confidence to touch and emotionally connect with their infants. As well as babies up to
2 years old, Liz also helps older children in the hospital who have developmental disabilities. Liz’s work is greatly appreciated by parents, many of whom spend extended periods at The Royal London Hospital. It can make a difficult experience just that little bit easier. £5,270 2017 Lucy Wootton, Health Play Specialist, Barts Health
Ruby, mum of Mikaeel (right)
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Our grants
At a glance…
The project: New programmes of research on cancer cells and the ‘tumour stroma’ – the tissue in which they grow. What’s being done: Research to accelerate the development and use of innovative new cancer therapies. Impact: New and more personalised treatments for cancer patients.
SUCCESS STORY
The little things matter Small but significant changes are making life more comfortable for cancer patients at St Bartholomew’s Hospital. The busy outpatient cancer wards at St Bartholomew’s Hospital see more than 100 patients a day, many of them undergoing regular sessions of chemotherapy; for some it can be like a second home. Their experience is constantly improving, thanks to a close partnership between staff on the wards and Barts Charity. Talking to patients, ward staff often come up with ideas for improving the patient experience. 14
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Through regular discussions with Barts Charity, projects can be identified that we are able to fund, often with money raised by grateful patients and families who want to show their gratitude for the care they or their loved one have received. Recent years have seen several innovations, including: Refurbishing of the salon providing wigs, head coverings and prosthetics for cancer patients New reclining chairs especially suited for chemotherapy sessions
A fully funded snack service, to keep patients’ energy levels up Redecoration of the chemotherapy pre-assessment room, creating a more welcoming space Purchasing of iPads to help visualise reconstructive surgery An extra biopsy chair to reduce waiting times for breast cancer patients Foldaway beds for unplanned overnight stays. The ideas keep coming, and this bartscharity.org.uk
Barts Charity funding will enable us to recruit a wealth of new scientific talent, to enable us to turn our ambitious plans into reality – and deliver real benefits to patients. Professor Nicholas Lemoine Director of Barts Cancer Institute
NEW FUNDING
Innovations in cancer therapy Thanks to our major funding, Barts Cancer Institute is expanding its groundbreaking programmes of research into innovative new ways of treating cancer. With cancer likely to affect one in every two people, there is an urgent need for new treatments. Barts Cancer Institute is one of the UK’s leading sites of cancer research, and our major new funding is enabling the Institute to expand its research into the cell biology of cancer. Our funding will support research in two related areas of cancer biology. The first focuses on the properties and behaviour of cancer cells themselves. The second reflects the fact that tumour cells modify surrounding cells, creating a nurturing and protective environment – the ‘tumour stroma’. If a cancer cell can be likened to a seed, then the tumour stroma represents the fertile soil enabling it to grow. Tackling cancer is likely to require strategies that target both
cancer cells and the tumour stroma. Within the first theme, three specific projects are being undertaken. In the first, new equipment will be used to create radioactively labelled probes to detect the recurrence and spread of prostate cancer cells. These probes will also be adapted so that they destroy the cancer cells they detect. In the second project, tumours will be analysed to identify specific features correlating with response to a new class of drugs known as ‘checkpoint inhibitors’, which boost the body’s own immune response to cancer cells. These features could be used to identify patients likely to respond to these promising new therapeutics. In the third project, a leading figure will be recruited to take forward a programme of research in cancer cell metabolism. The biochemistry of cancer cells is highly abnormal, and a deeper understanding of these
abnormalities could suggest new ways to disrupt cancer cell growth. For the second theme, the tumour stroma, our funding will again enable the Institute to appoint a new senior researcher. The new recruit will lead a programme of research to develop a better understanding of interactions between cancer cells and the tumour stroma – insight that will again underpin the development of new approaches to treatment. £4.5m 2017 and 2018 Prof. Nicholas Lemoine, Director, Barts Cancer Institute
highly successful partnership will continue helping patients well into the future. £41,000 2012
Barts Charity has been excellent, helping us with things we wouldn’t have been able to provide… little things add up and really do make a difference to patients. Holly Nuttall General Manager at St Bartholomew’s Cancer Centre until March 2018 bartscharity.org.uk
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Our grants
SUCCESS STORY
Shaping the future of trauma care Thanks to Barts Charity being prepared to back our vision in 2012, we are hopeful that we can create a sustainable international Centre for Trauma Sciences research that will improve outcomes for trauma patients, in London and worldwide, for a long time to come. Professor Karim Brohi Professor of Trauma Sciences and Consultant Trauma and Vascular Surgeon
The Centre for Trauma Science has shown that high-quality research can be carried out in emergency situations – and that such research can save lives and improve outcomes. In 2012, Barts Charity provided major funding to establish a new Centre for Trauma Science (C4TS), building on the renowned clinical trauma services at Barts Health and existing research at SMD. The main drive for the new initiative was the recognition that recent national reorganisations of trauma services – heavily influenced by work at Barts Health – could achieve only so much. What was also needed was a deeper understanding of the biological impact of trauma and rigorous testing of new treatments. C4TS therefore adopted an innovative, systems-wide approach, encompassing: Laboratory research to understand the immediate and
longer-term impact of injuries Clinical trial infrastructure able to manage research under challenging circumstances Training programmes to build capacity in trauma research Longer-term support for trauma patients (see right) Advocacy to raise awareness of the importance of trauma and trauma research (for example, through the #TransformTrauma initiative in partnership with Barts Charity). The Centre has focused on the first hours after injury. As well as being critical to immediate life-saving care, what happens in this window also impacts on later survival – on the risks of heart failure, later multi-organ failure, susceptibility to infection during recovery, and the likely success of rehabilitation.
At a glance…
The project: Developing a new Centre for Trauma Sciences (C4TS) at SMD. What’s been done: C4TS has established a platform for conducting high-quality research integrated into world-class trauma services. Impact: A deeper understanding of early biological responses to trauma that has underpinned the development of new life-saving treatments.
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SUCCESS STORY
Building a new life after injury C4TS has a strong focus on prevention of bleeding. The discovery that trauma was often associated with low levels of certain blood-clotting factors led to a highly successful pilot trial of a frozen blood product, cryoprecipitate, to enhance clotting. A large-scale international trial of cryoprecipitate is now underway. Through a combination of advances, C4TS has contributed to a remarkable halving of deaths from bleeding among Barts Health trauma patients. Laboratory studies are having further impact. For example, experimental work provided surprising new insights into major organ failure and suggested that artesunate – a drug already licensed to treat malaria – might be protective against organ failure. Laboratory studies confirmed this idea, and artesunate is now being evaluated in a clinical trial. The trauma team has also discovered that the immediate response to trauma varies from patient to patient. Around a dozen responses could be distinguished, linked to marked differences in survival and need for blood transfusions. The team is now developing diagnostics for rapid assessment of trauma patients, with a view to ‘personalising’ treatment to maximise their chances of recovery. Having demonstrated its ability to carry out research making a real difference to trauma care, C4TS has attracted some £5m additional funding from government, military, industry and charity sources. It now aims to cement its long-term position as a centre of excellence in trauma research – not least to address the projected 40% increase in trauma service use at Barts Health over the next decade.
The AfterTrauma app is empowering patients to rebuild their lives, with support from their peers. Increasing numbers of patients are surviving serious injury. Yet while they receive intensive support when in hospital, after discharge they are largely on their own – patients liken it to ‘falling off a cliff’. The Barts Health trauma team has long been frustrated by the lack of support to help patients redevelop lost skills and regain their physical health and emotional wellbeing when they return home. However, new digital technologies and the growing emphasis on self-management of long-term conditions – plus funding from Barts Charity – has opened up new opportunities to address this need. Working closely with trauma survivors, the C4TS team has created an app that enables patients to set and track rehabilitation goals, as well as access a wealth of information about their injuries and advice on managing physical and emotional challenges (including tips from other trauma survivors). It includes an online community
where trauma survivors can get in touch and support each other on their road to recovery. Patients begin by completing a questionnaire that generates a comprehensive assessment of their current situation, and they use this profile to establish targets to guide their rehabilitation. The app has been positively received through its testing phase. Moreover, several trauma centres have expressed a keen interest in adopting the app – which has been developed without any intellectual property restrictions, enabling it to be readily used by other centres in the UK and overseas.
No one should face trauma alone. Knowing that there’s advice, support and a network of people who understand to hand – quite literally – will make an enormous difference for both patients and their loved ones. Ella, 27 Trauma survivor (below right)
At a glance…
The project: Development of an app to support rehabilitation of trauma survivors and promote self-management. What’s been done: Trauma doctors and therapists have worked with trauma survivors to create an app enabling patients to develop tailored rehabilitation programmes, access information (including tips from other survivors) and connect with their peers. Impact: Better recovery and reintegration into day-to-day life for trauma survivors.
£2,939,255 2012 Prof. Karim Brohi, Professor of Trauma Sciences and Consultant Trauma and Vascular Surgeon bartscharity.org.uk
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Our grants We have pioneered an integrated data platform covering more than a million people – and now we want to expand it still further and show that we can use the data to manage population health challenges and ultimately save lives. Dr John Robson Clinical Reader in Primary Care Research and Development, SMD
NEW FUNDING
Mining the data mountain As well as improving clinical care, innovative linkage of health data could create a world-leading resource for research. Technological advances are creating new opportunities for ‘learning health systems’ – where patient data from multiple sources is captured electronically and feeds into future care. As a result, patients should receive better, safer and more personalised care. Data can also be used to improve the planning of services and for research. This exciting model is dependent on IT systems that enable data from multiple sources – such as GPs, hospitals, social care records, laboratory tests and health apps – to be captured and shared in real time, without compromising data privacy. East London has led the way nationally, with SMD, Barts
SUCCESS STORY
It’s so much better than before. I can just play on my phone or sleep while it’s being done. I’ve had two strokes so it’s important for me to have regular transfusions. Bami, 22 A sickle cell disease patient benefiting from apheresis
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Health, local Clinical Commissioning Groups and 300 GP practices already collaborating to develop a shared data platform covering 1.2 million patients. This platform has enabled East London to achieve remarkable success in clinical performance – ranking in the top three nationally for a quarter of performance indicators – despite serving a highly disadvantaged population. Furthermore, the platform may be globally unique, given its coverage of the entire local population and all health services – providing an unprecedented resource for research. Now, the REAL-Health (ResearchEnabled Learning Heath System) consortium aims to build on this platform to enhance the quality of care and generate new knowledge in three key areas:
Cardiovascular medicine To improve long-term management of heart disease, new electronic tools will be developed to enable GPs to provide the best and safest treatments. The team’s goal is to prevent 400 heart attacks and strokes over three years. Asthma Asthma affects one in ten local people, but is often poorly controlled, which can lead to emergency hospital admission and even death. New tools will be developed to identify patients at high risk of a severe attack, who will then be offered intensive support in asthma management. The team estimates it can reduce unplanned hospital admissions by 10%.
Exchanging blood Patients with sickle cell disease are benefiting from two new apheresis machines that automatically remove damaged red blood cells. Sickle cell disease is an inherited condition causing red blood cells to become misshapen or sickleshaped. They can end up blocking blood vessels, damaging organs and causing severe pain. To manage their condition, people with sickle cell disease undergo regular treatment to remove sickled red blood cells, which are replaced with donor cells. Traditionally, this has involved either blood transfusions or manual exchange
bartscharity.org.uk
At a glance…
The project: Developing a ‘learning health system’ in East London. What’s being done: Researchers, clinicians and IT specialists will work together to develop new data linkage and IT tools to enhance the quality of care offered to patients, focusing on heart disease, asthma and childhood conditions.
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feeling better for longer, and fewer require emergency admissions to hospital. Some centres treat two to four patients a week, but the Barts Health unit sees that many every day. Staff have developed high levels of expertise, and the Barts Health unit has become a national reference centre, helping to train and advise other units nationally and internationally. £132,000 2017 Dr Paul Telfer, Consultant
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transfusions every 3–4 weeks, a procedure that takes several hours. Transfusions can also lead to iron overload, requiring further treatment. Our funding has enabled Barts Health to acquire two apheresis machines, which are having a big impact on patients’ lives. The machines filter out red blood cells from blood, which is then returned to patients along with replacement red blood cells from donors. The procedure is quicker, lasting just two and a half hours, and more efficient, so patients need treatment only every 6–12 weeks. Patients report
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Child health New data linkages will be established to examine the impact of childhood obesity on physical and mental health, and to track the health and educational development of children born with rare inherited disorders.
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Impact: Fewer heart attacks and strokes, fewer emergency admissions after asthma attacks, and a deeper understanding of childhood obesity and rare diseases.
At a glance…
The project: Purchase of two apheresis machines to treat people with sickle cell disease and other inherited disorders affecting red blood cells. What’s been done: The new machines specifically remove patients’ red blood cells, a key part of the care of patients with these conditions. Impact: The procedure is quicker, needs to be carried out less often, and is less draining on patients. Annual Report 2017/18
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Our grants NEW FUNDING
Taking charge of asthma control
Schools workshops could enable children to better manage their asthma, while an accompanying drama production is challenging the stigma surrounding the condition. On average, around three children in every classroom have asthma, although numbers are typically higher in urban areas such as London. It is also potentially deadly: in 2016, more than 1,200 children died of asthma in England and Wales.
At a glance…
The project: Development of an innovative schoolsbased programme to improve children’s asthma control. What’s being done: A trial will assess whether workshops for children with asthma, and an interactive theatre performance for all children, help children better manage their asthma.
For most children, asthma can be controlled by medication, reducing the risk of severe asthma attacks. However, in her PhD project, Kate Harris identified a wide range of reasons why secondary school children across London did not manage their condition as well as they might. Lack of knowledge was important, but so too were factors such as simple forgetfulness, worries about what their peers might think, and a feeling that it was hard to talk to GPs about their condition. Based on these findings, Kate, Dr Gioia Mosler and colleagues have developed engaging and interactive workshops that specifically address the obstacles to effective asthma management. The workshops include entertaining and informative activities, including an asthma-themed board game (above). The team is running a clinical trial, comparing asthma control in children in schools
running the workshops and those in similar schools (which will have a chance to host the workshops in the future). Complementing the workshops, a theatre performance has been developed to engage all children in issues around asthma. The thought-provoking storyline centres on a character with asthma who doesn’t tell anyone about her condition for fear of what others will think – and who has a severe episode of asthma as a result. After the performance, actors stay in character and discuss the issues raised with children in the audience. £458,000 2017 Prof. Jonathan Grigg, Professor of Paediatric Respiratory and Environmental Medicine
Impact: The programme could significantly reduce the number of life-threatening episodes of asthma in schoolchildren.
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SUCCESS STORY
This approach engages with children in a completely different way, on an emotional level. If we see positive results we’ll be able to use the data for a larger-scale study to increase understanding of asthma and improve self-management. Professor Jonathan Grigg Professor of Paediatric Respiratory and Environmental Medicine
A black mark for air pollution Children with cystic fibrosis in London are being exposed to alarming levels of ‘black carbon’. Cystic fibrosis is an inherited condition causing thick mucus to accumulate in the lungs. Children with the condition require intensive physiotherapy of up to an hour every day to clear excess mucus from their lungs. They also are particularly vulnerable to lung infections; lung complications mean that only half of people with cystic fibrosis live beyond their 40s. In Professor Jonathan Grigg’s team, Dr Norrice Liu is studying the likely impact of airborne particles of soot, or ‘black carbon’, on the lungs of London children with cystic fibrosis. A group of children have been wearing special devices that collect and filter air, which have already shown that children are exposed to disturbingly high levels of black carbon during their journeys to school. Foreign material entering the lung is hoovered up by cells known as macrophages, which act as cellular vacuum cleaners. However, macrophage function is abnormal in people with cystic fibrosis. Dr Liu is examining how well the macrophages of children with cystic
fibrosis clear carbon particles, and whether inadequate clearance might trigger inflammation that could damage the lungs. Initial findings suggest that macrophages in the airways of children with cystic fibrosis are less able to hoover up inhaled particles. These pollutant particles may therefore damage areas of the lung that are normally protected by airway macrophages. £375,796 2016 Prof. Jonathan Grigg, Professor of Paediatric Respiratory and Environmental Medicine
Children with cystic fibrosis have a tough time as it is – but air pollution could be making things much worse for them. Dr Norrice Liu Clinical Fellow
At a glance…
The project: Assessing the impact of ‘black carbon’ air pollution on the lungs of London children with cystic fibrosis. What’s being done: Researchers are measuring how much black carbon children with cystic fibrosis are exposed to, and how well cells in their lungs dispose of carbon particles. Impact: Evidence of harm would strengthen the case for the introduction of legal limits on black carbon levels. bartscharity.org.uk
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Our grants
SUCCESS STORY
Enhancing kidney care The award-winning Barts Diabetic Kidney Centre is having a profound impact on care, prevention and research. In 2015, we awarded a £3.4m grant to establish a new Barts Diabetic Kidney Centre. Kidney damage is one of the most devastating consequences of diabetes, leaving patients in the need of dialysis and potentially a kidney transplant. It has a major impact in East London – for example, 8% of people in Newham have diabetes – but given the area’s ethnically diverse population, lessons learned here could be of global significance. In a remarkably short space of time, the Centre has achieved considerable impact in all its areas of interest. Diabetes care: Building on an electronic health record system shared among local general practices – collectively serving a population of 1.1 million people – hospital kidney specialists have established an integrated ‘e-clinic’ approach to kidney care. When GPs think that specialist input is required, they now make
an electronic referral. Hospital consultants can instantly view a patient’s full health record, and are much better placed to advise on the appropriate course of action. The 14 consultants involved can offer more rapid support – referral times have dropped from 18 weeks to 2 weeks – and can concentrate on those most in need of specialist care. This innovative approach was highly commended in the prestigious 2017 Health Service Journal Awards. Education: The team has also established an outreach programme, organising group sessions and one-to-one meetings for those at risk of kidney disease, to encourage the uptake of lifestyle changes to protect kidney health. The nurse running this programme won the British Journal of Nursing’s 2018 Renal Nurse of the Year award. Clinical trials: The new systems have created a platform enabling more patients to be recruited into clinical trials of new treatments – the area is now one of the highest recruiting centres in London.
Perhaps most significant is a major new study using multiple approaches to track the progression of kidney disease. As well as distinguishing different types of kidney disease – potentially allowing for more tailored treatments – the study will create a biobank of samples to support research. The value of the study has been reflected in multimillion pound backing by a major pharmaceutical company. Research: A programme of research is exploring mechanisms of kidney disease. In particular, researchers are investigating abnormalities in podocytes, cells that form sieve-like structures in the kidney. If these sieves develop holes, proteins begin leaking into urine. Notably, the team has found that certain cancer drugs correct abnormalities in podocytes, suggesting a possible new approach to treatment. £3,369,000 2015 Dr Neil Ashman, Consultant
By helping people take better care of their kidneys, we can significantly delay the need for dialysis, which can have a major impact on patients’ lives. At a glance… Dr Neil Ashman Consultant, Barts Health
The project: Creating a new Barts Diabetic Kidney Centre. What’s being done: A new ‘e-clinic’ system is enabling hospital kidney specialists to work more closely with GPs. Impact: The new system has reduced referral times from 18 weeks to 2 weeks and led to better patient care, increased recruitment to clinical trials, and underpinned a major programme of research into diabetic kidney disease.
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bartscharity.org.uk
At a glance…
The project: Launch of Brainbook. What’s being done: The Brainbook website and social media provide patients, the public and healthcare professionals with novel insight into brain surgery. Impact: Brainbook supports dialogue and sharing of good practice among health professionals, but also enables patients and the public to discover what brain surgery actually involves.
SUCCESS STORY
Opening up the brain
The Brainbook project is opening up brain surgery to the public and professionals alike. The brain is endlessly fascinating, and brain surgery is one of the most awe-inspiring of medical specialties. But what actually goes on behind the closed doors of the operating theatre? This is the question that has motivated the Brainbook team, which is aiming to open up the world of brain surgery. With our funding, it is using its website and social media to support dialogue between the neurosurgeons
carrying out procedures and other interested parties – surgeons keen to discuss the best approaches to particular medical challenges, patients scheduled for operations and their families, and just those with an interest in pioneering medical procedures. The insiders’ view may also inspire young people to pursue medicine and medical students to specialise in neurosurgery. The website (www.realbrainbook. co.uk) includes clips of surgery, medical illustrations and
Our profession is built on serving the public, yet we do a disservice by not doing everything we can to involve our patients with our decisions, to gain feedback and perspectives from them, and to inspire young people to carry our profession forwards. Dr Priya Rogers Co-founder, Brainbook
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blog posts directed at the different target audiences, while Twitter conversations support dialogue about actual patient cases. The result is a fascinating insight into a seldom-glimpsed area of medicine – not just into the technicalities of intricate surgery but also into the minds of those who carry it out and on whom patients’ lives depend. £5,000 2017 Mr Alex Alamri, Neurosurgery Registrar; Mr Chris Uff, Consultant Neurosurgeon; and Dr Priya Rogers, Academic Foundation Doctor
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Our grants
Dr William Alazawi, Reader and Consultant in Hepatology.
NEW FUNDING
Halting the march of liver disease A team of liver researchers is aiming to stem the worrying rise of liver disease in East London. While death rates from many diseases have been in steady decline in recent years, deaths from liver disease have increased by a staggering 500% since 1970. Moreover, East London is a ‘hot spot’ for liver disease – Newham, for example, has the fourth highest rates in England. Liver disease has many causes, the most significant being infection with hepatitis viruses (especially B and C) and the damaging build up of fatty tissue due to obesity or excessive alcohol consumption. In theory, these causes are all preventable – and
SUCCESS STORY
Thanks to Barts Charity we’re developing completely new ways of assessing and stratifying patients based on their immune responses – the first time this has been done in the UK. Dr Patrick Kennedy Reader in Hepatology and Honorary Consultant Hepatologist
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prevention is the ultimate goal of three liver researchers who, with our funding, have created a new Barts Liver Centre. We are supporting three key projects:
Optimising treatment of hepatitis B virus: By analysing thousands of hepatitis B virus samples, the researchers aim to identify features of the virus associated with severe liver disease. This could help to identify patients at risk of liver complications and most in need of intensive clinical attention. Understanding progression to fatty liver disease: Build up of fat can trigger inflammation, which
damages the liver. The Barts team has found that a protein known as TLR5 might be playing a key role in liver inflammation. It is now working with the East London Genes & Health project, also funded by Barts Charity, to identify and study local people who lack TLR5, to find out more about its role in inflammation – an understanding that could highlight ways to prevent disease developing. Promoting exercise in problem drinkers: The Barts team has joined forces with local professional football clubs to provide a supervised exercise programme for
Tailoring treatment of hepatitis B
Thanks to pioneering research on young adults with hepatitis B virus infections, clinicians can now focus attention on patients in greatest need – reducing their risks of serious liver disease and cancer. Hepatitis B virus (HBV) infections are common in East London, particularly among migrant communities. Often, the virus establishes long-lasting (chronic) infections, and initially patients may experience few if any symptoms. However, many later go on to develop severe liver disease and cancer. Dr Patrick Kennedy (left) runs a busy clinic for young adults with bartscharity.org.uk
Barts Charity funding has enabled us to establish the Barts Liver Centre, which will be a focal point for liverrelated research, and provide a springboard for further studies on this growing threat to the health of East Londoners. Professor Graham Foster Professor of Hepatology
those drinking to excess. The aim is to convert a harmful addiction to alcohol into a beneficial addiction to exercise. £1.3m 2017 Prof. Graham Foster, Professor of Hepatology; Dr Patrick Kennedy, Reader in Hepatology and Honorary Consultant Hepatologist; and Dr William Alazawi, Reader and Consultant in Hepatology
At a glance…
The project: Creation of the Barts Liver Centre. What’s being done: Research to prevent liver disease, focused on hepatitis B virus infection, the mechanisms of inflammatory liver disease, and an exercise programme for problem drinkers. Impact: Fewer people locally developing serious liver disease.
HBV in East London. While patients with chronic HBV infections are typically not treated until they begin to show signs of liver damage, Dr Kennedy believes that earlier treatment would do more to prevent later-stage liver damage. However, intensive treatment of all younger patients would be expensive and impractical. In a bid to identify young adults who would benefit most from early treatment, Dr Kennedy and his colleagues have carried out pioneering studies examining their immune responses to HBV. These have revealed distinctive signatures bartscharity.org.uk
associated with effective control of HBV, and others indicating that the virus may be replicating and damaging the liver. The highly successful project has greatly strengthened the case for early intensive treatment of young adults with HBV. It has generated a dozen papers in high-profile scientific journals, and the results have provided the basis for a further successful grant application to the National Institute for Health Research. More immediately, however, Dr Kennedy is using the immune response signatures to identify
patients for novel intensive treatment approaches and care pathways. His busy clinical service can therefore prioritise those most in need, and spare those who require less monitoring from unnecessary visits to the clinic. £472,000 2014 Dr Patrick Kennedy, Reader in Hepatology and Honorary Consultant Hepatologist
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Our supporters Each year we are overwhelmed by the efforts and achievements of our inspiring supporters, and this year has been no exception. From running multi-marathons to companies making us their charity of the year, they are going the extra mile to help us contribute to the extraordinary work that goes on each day across the hospitals that we support.
We are also pleased that the Charity Champions scheme – a new programme involving hospital staff – has made amazing progress in its first year. Our rapidly growing team of Champions are building awareness of us among staff and patients. Our Champions also feed back and help us to ensure that we are making the biggest difference possible.
In the wider community, our dedicated Barts Charity Ambassadors continue to fly the flag for our activities and we are immensely thankful for the generosity of the many individuals, local businesses and national organisations that support our work.
Transforming trauma with Professor Green The Barts Charity trauma appeal is really important and I owe my life to the trauma teams who saved me. I am always grateful and I have used my experiences for inspiration for my music. Professor Green
Professor Green in conversation with trauma specialist Professor Karim Brohi.
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In September 2017, Professor Green headlined a night of music in Shoreditch’s Village Underground venue and performed to an intimate audience of 600 people, including 20 lucky competition winners who got to meet the rapper backstage. The event was a highlight of our Transform Trauma campaign. Professor Green, aka Stephen Manderson, survived a near-fatal stabbing in 2009 thanks to the rapid and life-saving treatment he received from the trauma team at The Royal London Hospital. Four years later he was again treated for traumatic injury after a car accident, and is now a passionate supporter of our appeal to raise awareness of the importance of trauma research. The gig shone a spotlight on trauma and its key role in saving lives – whether in response to terrorist attacks, gang violence or the daily catalogue of traffic accidents, falls and burns that can change lives in an instant. bartscharity.org.uk
Winter wonderland We are currently enjoying the second year of a three-year partnership with insurance company Aspen UK. The company is committed to helping the Charity provide specialist cardiac equipment at Barts Heart Centre, and to supporting the educational work we fund at the Blizard Institute’s Centre of the Cell, inspiring local schoolchildren to consider careers in science.
Last Christmas, Aspen also donated presents to children at The Royal London Hospital and their staff transformed the Healing Space on the children’s ward into a magical winter wonderland. Tara Shea, Clinical Lead of the Play Department, said: “Thanks to Aspen, all our young patients were able to visit Santa’s grotto without leaving the hospital, and received a wrapped present of their very own.”
Norah’s lasting tribute
Norah Reed began fundraising for the oncology department at St Bartholomew’s Hospital after the death of her husband in 1991. Since the Barry Reed Cancer Research Fund was established, more than £800,000 has been raised through a variety of fundraising events, including a major summer concert. One of the ways that the fund is being used is to support the next generation of researchers working on cutting-edge projects in cancer:
27 years ago, the last promise I made to my husband Barry, the day before he died of leukaemia, was that I would work, in some way, to try to find a cure for all forms of cancer. My hope for the future is that one day one of our PhD funded students will make that breakthrough and my promise will become a reality.
A Costa Rican challenge
Mayors for medicine The mayors of Waltham Forest have a special link with Whipps Cross Hospital – 2018 marks 18 years of their support. In October 2017, we unveiled a plaque at the hospital in commemoration. Alan Gurney, Managing Director of Whipps Cross Hospital, said at the unveiling: “It is thanks to their generosity, passion and energy that bartscharity.org.uk
hospital patients, families and the local community are benefiting from enhancements in healthcare. “An exceptionally strong relationship has existed between the Waltham Forest Mayoralty and Whipps Cross Hospital for many years and we’re very grateful for the extraordinary support all mayors have shown.”
In February 2018, Dr Rosel Tallach, consultant anaesthetist at The Royal London Hospital, took on an incredible endurance feat, tackling six marathons in six days during the Costa Rican Coastal Challenge. Raising over £2,000, she came an impressive 10th out of 95 runners. As part of a team that treats trauma patients daily, Rosel said: “What is done in the first few hours is important but what happens after that is even more crucial for a trauma patient’s quality of life.” Extraordinary staff like Rosel are not only having a huge impact on patients each day, they are also willing to go the extra mile to support the hospitals they work in. Annual Report 2017/18
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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. In 2014, it became the first NHS charity to become fully independent of the Department of Health.
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 12 such Trustees, and one additional Trustee has been appointed since then. 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 Company Secretary 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 (although not all Board Advisers sit on a committee). Board Advisers are appointed for an initial two-year term, renewable to five years in total. Both new Trustees and new Board Advisers undergo 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 HR benefits 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, Charles Wells plc and the Classic Prop Company; formerly partner and member of Executive Board of PricewaterhouseCoopers LLP.
William Medlicott Deputy Chairman Chartered Accountant; Client Director, Capital Cranfield Trustees Ltd; formerly Finance Director for ITV Broadcasting, part of ITV plc.
Nick Anstee Chartered Accountant; formerly Lord Mayor of London 2009/10 and Senior Director at City law firm King & Wood Mallesons LLP.
Vijay Bharadia Chartered Accountant; International Chief Financial Officer at the Blackstone Group; formerly Co-Chief Financial Officer for European Equities at Merrill Lynch & Co. 30
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Claire Brown (Board Adviser) Chartered Accountant; consultant, trustee and coopted member of investment and audit committees for the Nuffield Foundation, the Royal Foundation and Comic Relief; formerly Finance and Investment Director of the Esmée Fairbairn Foundation.
Andy Bruce Partner, Global Head of Real Estate, Linklaters LLP solicitors.
Sally Flanagan Director of Unquoted Investments at Caledonia Investments plc; formerly Head of Healthcare Investment teams at Private Equity investors, Permira and PPM Capital (now Silver Fleet).
Dominic Hollamby (Board Adviser) Chartered Accountant; ViceChairman of Rothschild Bank, Global Head of Healthcare/Life Sciences and Pharmaceuticals; formerly partner at Arthur Andersen.
Dame Professor Parveen Kumar Professor of Medicine and Education at SMD and Consultant Gastroenterologist; President of the Royal Medical Benevolent Fund and the Medical Women’s Federation; Trustee of British Youth Opera.
Professor John Monson Emeritus Professor of Clinical Endocrinology at Barts and The London School of Medicine and Dentistry.
Sir Stephen O’Brien CBE Chairman and President of a number of charities and third sector organisations in healthcare and social enterprise; formerly Chairman of Barts Health NHS Trust.
Dr Thomas Round GP at the Bromley by Bow Health Partnership; Academic Clinical Research Fellow in Primary Care and Public Health Sciences at King’s College London. bartscharity.org.uk
SENIOR MANAGEMENT
Professor John Shepherd Emeritus Professor of Surgical Gynaecology at SMD; 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, SMD; Visiting Professor, University College London; Visiting Professor at Juntendo University, Tokyo, Japan; external faculty, Harvard Medical School, Boston, USA.
Appointments and Remuneration Committee Paul Rawlinson (Chairman) Andy Bruce William Medlicott
Finance and Audit Committee William Medlicott (Chairman) Nick Anstee Vijay Bharadia Claire Brown 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
Investment Committee Leopoldo Zambeletti (Board Adviser) 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.
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Andy Bruce Sally Flanagan William Medlicott Paul Rawlinson
Fiona Miller Smith Chief Executive
Fiona Bickley Chief Operating Officer
Clare Chater Director of Engagement and Community Fundraising
Francesca Gliubich PhD Director of Grants
Arati Patel Director of Finance and Operations
Ilia Ralphs Director of Major Gifts As at 18 July 2018
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Finance Finance review and strategic report Thanks to the strong performance of our investments in the last five years, supported by an increase in income from both fundraising and investments this year, we were able to achieve our target charitable giving of £30m. Total gross asset base: £464m Net assets: £411m Total charitable giving: £30m 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
Barts Charity’s financial strategy is based on a sound and efficient management framework designed to sustain annual grant-giving and operating activities in perpetuity. Net assets at year-end were £411m (Figure 1), a reduction of 2.6% (£422m in FY2016/17), reflecting the Charity’s decision to deploy some of its capital to fund a much higher level of charitable giving (£30m in FY2017/18 compared to £12.7m in FY2016/17). Income has increased (Figure 2), with the investment portfolio generating £15.4m (£13.7m in FY2016/17) and fundraising generating £4.2m (£3.7m in FY2016/17). While the investment environment is becoming more challenging, the Charity’s policies remain committed to sustaining a diversified and resilient portfolio to enable the Charity to ride out periods of investment downturn.
Total expenditure for FY2017/18 was £33.8m (£16.1m in FY2016/17), of which £30.1m related to charitable activities (£12.7m in FY 2016/17, Figures 3, 4). The significant increase is evidence of our commitment to fund grant-giving of £30m until at least FY2019/20, which in turn reflects the desire of the Trustees to apply some of the portfolio gains achieved in recent years and to grow fundraising income so as to sustain a larger annual grants programme. The total cost of raising funds – expenditure on fundraising activities and management of the investment portfolio – was £3.6m in FY2017/18 (£3.4m in FY2016/17). Of this figure, £2.6m relates to management of investments. Costs relating to financial investments (£1.9m) amount to less than 1% of asset value (exclusive of private equity and private credit). The annual spend linked to propertyrelated investments in FY2017/18 was £0.7m against an average asset value of £128.2m, representing 0.5% of asset value. The property assets are predominantly multi-let commercial properties in London and the South-East. Staff remuneration is determined by reference to a salary survey carried out by specialist reward consultants. The benchmarking data allow us to fix a salary range for each post, taking into account a number of factors such as the location, size and complexity of our organisation.
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Summary of expenditure
Figure 3:
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Restricted funds Unrestricted funds Capital in perpetuity
£30.19m
Fundraising
£1.01m
Financial investment management
£1.86m
Property investment management
£0.69m
Expendable endowment See note 1.3 to the accounts for details of fund structure
Figure 2:
Income
Figure 4:
20
Charitable activities
30 £m
£m
25 15 20 10
15
10 5 5
0
8
7 /1
6
17 /1
20
16
/1
20
5 /1
15 20
14 3/
14 20
20 1
8 17 /1
7 /1 16
/1 15
20
20
20
6
5 /1 14
3/
14
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 FY2017/18, new commitments within the private equity and private credit allocation have helped bring the portfolio more in line with the strategic asset allocation of the investment portfolio (Table 1, overleaf). This also allows for access to differentiated exposures outside of public markets. 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. Public 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). Shifts within the public equity targets have resulted in greater geographic diversification with less UK/GBP exposure. We have additional holdings in both private equity and private credit, which currently account for 3.3% and 3.4%, respectively, of the total investment portfolio, although these allocations are targeted to grow over the next 3–5 years. Measured against standard benchmarks, the investment portfolio is achieving sound performance during continuing economic uncertainty, with growth of 3.7% in FY2017/18 (Table 2, overleaf). As of 31 March 2018, the portfolio has achieved a return of 10.5% annualised per year over the last three years. The target for the portfolio is to earn an average real return of 4.5% over a rolling three-year period. This has been achieved since the inception of the current portfolio in November 2005.
Net assets
Figure 1:
20 1
Investment review
Other income Legacies and donations Stocks, shares and cash dividends Property
Annual Report 2017/18
33
Finance Investment review cont.
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 properties such as multi-let offices; 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.
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Annual Report 2017/18
Table 1:
Asset allocation FY2017/18 (%)
FY2016/17 (%)
FY2015/16 (%)
Target (%)
Growth drivers (public and private equity)
48.3
49.0
46.7
51.0
Diversifiers (public and private credit)
16.8
14.2
9.9
11.0
Inflation hedging (property and commodities)
29.6
32.2
35.1
32.0
Deflation/disaster hedging (fixed income and cash)
5.2
4.5
8.3
6.0
Table 2:
Total investment portfolio performance Cumulative trailing 1 Year (%)
Annualised trailing 3 Year (%)
Annualised since November 2005 (%)
Total assets
3.7
10.5
9.6
Long-term policy benchmark
4.9
7.5
6.2
Value added
–1.1
3.0
3.4
Total assets excl. private investments
2.8
7.2
6.4
Long-term policy benchmark
2.5
6.7
6.9
Value added
0.3
0.5
–0.5
Total assets excl. property
2.7
7.6
6.5
Long-term policy benchmark
2.7
7.0
7.0
Value added
0.0
0.6
–0.4
bartscharity.org.uk
Future plans
Reserves and risks
Areas of particular focus for FY2018/19 are: to sustain a high-quality grant-giving programme to deliver a transformational level of funding needed by 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;
Reserves policy
to update our branding and roll-out across all digital and non-digital outlets;
to maintain the ‘real’ purchasing power of the reserves such that Barts Charity can exist in perpetuity;
to undertake a stakeholder survey to inform a new communications strategy and the possible launch of a brand awareness campaign;
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 raise our profile and influence across the five hospitals of Barts Health by implementation of integrated fundraising through greater engagement with Barts Health staff, patients and their families; to continue the expansion of our major gifts fundraising programme to achieve a significant increase in income by 2020.
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.
Donations and grants
(greater than £50,000) Tom Baker
Barbara Boucher Charles Wolfson Charitable Trust Quies Trust c/o Turcan Connell Whipps Cross Hospital League of Friends Plus one anonymous donation
Legacies Legacies £5,000 and over Kathryn Anderson
Gwendoline Austin Eileen Baker Blanche Broomfield Derek Clark
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.
bartscharity.org.uk
Donations and grants
Andrew Colliver Lilian Coppin Roy Doughty Marjorie Frost Rena Gerrard Gerald Gigney Frank Janes Muriel Jones Paul Levy Thomas McKeagney Pamela Smart Irene Stanley Dr C J Stevenson Michael Tishler Betty White William Wingate Ada Wright
Annual Report 2017/18
35
Accounts Independent auditor’s report to Barts Charity We have audited the financial statements of Barts Charity (‘the charitable company’) for the year ended 31 March 2018 which comprise the Statement of Financial Activities (including income and expenditure account), Balance Sheet and the Cash Flow Statement and related notes, including the accounting policies in note 1. 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 2018 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 accounting standards, including FRS 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland; and have been prepared in accordance with the requirements of the Companies Act 2006. Basis for opinion We conducted our audit in accordance with International Standards on Auditing (UK) (‘ISAs (UK)’) and applicable law. Our responsibilities are described below. We have fulfilled our ethical responsibilities under, and are independent of the charitable company in accordance with, UK ethical requirements including the FRC Ethical Standard. We believe that the audit evidence we have obtained is a sufficient and appropriate basis for our opinion.
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Annual Report 2017/18
Going concern We are required to report to you if we have concluded that the use of the going concern basis of accounting is inappropriate or there is an undisclosed material uncertainty that may cast significant doubt over the use of that basis for a period of at least 12 months from the date of approval of the financial statements. We have nothing to report in these respects. Other information The Trustees are responsible for the other information, which comprises the Trustees’ Annual Report, and the Finance Review and Strategic Report. Our opinion on the financial statements does not cover the other information and, accordingly, we do not express an audit opinion or, except as explicitly stated below, any form of assurance conclusion thereon. Our responsibility is to read the other information and, in doing so, consider whether, based on our financial statements audit work, the information therein is materially misstated or inconsistent with the financial statements or our audit knowledge. Based solely on that work: we have not identified material misstatements in the other information; in our opinion the information given in the Trustees’ Annual Report, which constitutes the strategic report and the directors’ report for the financial year, is consistent with the financial statements; and in our opinion those reports have been prepared in accordance with the Companies Act 2006.
Matters on which we are required to report by exception Under the Companies Act 2006 we are required 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. We have nothing to report in these respects. Trustees’ responsibilities As explained more fully in their statement set out on page 37, 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; such internal control as they determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error; assessing the charitable company’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern; and using the going concern basis of accounting unless they either intend to liquidate the charitable company or to cease operations, or have no realistic alternative but to do so.
bartscharity.org.uk
Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue our opinion in an auditor’s report. Reasonable assurance is a high level of assurance, but does not guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of the financial statements. A fuller description of our responsibilities is provided on the FRC’s website at www.frc.org.uk/ auditorsresponsibilities. The purpose of our audit work and to whom we owe our responsibilities 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.
Fleur Nieboer (Senior Statutory Auditor) for and on behalf of KPMG LLP, Statutory Auditor Chartered Accountants 15 Canada Square, London E14 5GL 24 July 2018
bartscharity.org.uk
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; Assess the charitable company’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern; and Use the going concern basis of accounting unless they either intend to liquidate the charitable company or to cease operations, or have no realistic alternative but to do so. 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 are responsible for such internal control as they determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error, and 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 18 July 2018
Annual Report 2017/18
37
Accounts Statement of Financial Activities (including income and expenditure account) for the year ended 31 March 2018 Notes
Income Donations Legacies Other Total voluntary income Income from investments Total income
Unrestricted funds £000
Restricted Endowment funds funds £000 £000
2018 Total funds £000
2017 Total funds £000
233 103 0 336 14,632 14,968
1,597 1,877 415 3,889 763 4,652
0 0 0 0 0 0
1,830 1,980 415 4,225 15,395 19,620
1,243 1,431 986 3,660 13,715 17,375
1,011
0
0
1,011
892
1,863 689 3,563
0 0 0
0 0 0
1,863 689 3,563
1,700 783 3,375
27,161 30,724
3,027 3,027
0 0
30,188 33,751
12,742 16,117
1,149
10
1,996
3,155
58,239
(14,607)
1,635
1,996
(10,976)
59,497
(3)
3
0
0
0
Net movement of funds
(14,610)
1,638
1,996
(10,976)
59,497
Reconciliation of funds Fund balances brought forward at 31 March 2017
110,906
20,227
290,579
421,712
362,215
Fund balances carried forward at 31 March 2018
96,296
21,865
292,575
410,736
421,712
2 7.3
Expenditure Raising funds: Voluntary fundraising costs Investment management costs: Financial Property Total cost of raising funds Charitable activities Total expenditure Net gains/losses on investments Gains/(losses) on revaluation and disposal of investment assets Net (expenditure)/income Transfers between funds
3.1 3.5
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.
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Annual Report 2017/18
bartscharity.org.uk
Balance Sheet as at 31 March 2018 Notes Unrestricted funds £000
Fixed assets Intangible and tangible assets Heritage assets Investments Total fixed assets
Restricted Endowment funds funds £000 £000
2018 Total funds £000
2017 Total funds £000
5 6 7.1
196 0 132,889 133,085
0 0 25,407 25,407
0 14,428 278,147 292,575
196 14,428 436,443 451,067
154 14,428 439,575 454,157
8.1
4,674 8,020 12,694
0 0 0
0 0 0
4,674 8,020 12,694
4,724 985 5,709
9.1
(23,367)
(2,618)
0
(25,985)
(21,501)
Net current (liabilities)/assets
(10,673)
(2,618)
0
(13,291)
(15,792)
Total assets less current liabilities Creditors: amounts falling due after more than one year
122,412
22,789
292,575
(26,116)
(924)
0
96,296
21,865
Current assets Debtors Cash at bank and in hand Total current assets Creditors: amounts falling due within one year
9.2
Total net assets
437,776
438,365
(27,040)
(16,653)
292,575
410,736
421,712
Funds of Barts Charity Capital funds: Endowment funds
10.1
0
0
292,575
292,575
290,579
Income funds: Restricted funds
10.2
0
21,865
0
21,865
20,227
10.3
95,550 746
0 0
0 0
95,550 746
110,099 807
96,296
21,865
292,575
410,736
421,712
Unrestricted funds General funds Designated funds Total funds
The notes on pages 41–52 form part of these accounts.
Paul Rawlinson Chairman 18 July 2018
bartscharity.org.uk
William Medlicott Trustee
Annual Report 2017/18
39
Accounts Cash Flow Statement for the year ended 31 March 2018 Notes
Cash flows from operating activities Net cash used in operating activities Cash flows from investing activities Dividends, interest and rents from investments Payments to acquire tangible and intangible fixed assets Payments to acquire investment assets Receipts from sales of investment assets Net cash provided by (used in) investing activities Change in cash and cash equivalents in the reporting year Cash and cash equivalents at the beginning of reporting year Cash and cash equivalents at the end of reporting year
11.1
2018 £000
2017 £000
(13,785)
(14,764)
14,598 (171) (27,721) 34,114 20,820
13,669 (19) (41,693) 43,689 15,646
7,035
882
985
103
8,020
985
The notes on pages 41–52 form part of these accounts.
40
Annual Report 2017/18
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 2017/18
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.
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Annual Report 2017/18
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 – Global Standards 2017, incorporating IVSC International Valuation Standards. 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 2018. 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 Barts Charity’s Memorandum and Articles of Association is in place to meet 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. Where individual investment managers have discretion to use financial instruments, valuation is in line with market practice.
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 2017/18 and 2016/17. Employer contributions were 14.38% for 2017/18 and 14.3% for 2016/17. Employees employed after 1 April 2011 can choose to belong to a Defined Contribution Scheme, which is a Group Personal Pension Scheme. For 2017/18 and 2016/17, the rates of employer contribution for the Defined Contribution Scheme were 9% for senior managers and 7% for other staff. Employee contributions are voluntary.
Details of 2 voluntary income Unrestricted funds £000
Restricted Endowment funds funds £000 £000
Donations Legacies Other Total 2018
233 103 0 336
1,597 1,877 415 3,889
0 0 0 0
Total 2017
1,133
2,527
0
2018 Total funds £000
2017 Total funds £000
1,830 1,980 415 4,225
1,243 1,431 986 3,660 3,660
Voluntary income includes one substantial legacy of £750,000 and an associated donation of £250,000.
bartscharity.org.uk
Annual Report 2017/18
43
Accounts Notes to the accounts GrantActivities funded undertaken activity directly £000 £000
Details of 3.1 charitable activities by funding source
Staff and support costs £000
2018 Total funds £000
2017 Total funds £000
Research Enhancement in service delivery Innovation and training Patient and community engagement Others Total Reversal of prior years’ grants (a) Total after reversal of prior years’ grants
14,059 13,687 102 489 0 28,337 (697)
1 18 482 147 568 1,216 0
543 532 100 44 113 1,332 0
14,603 14,237 684 680 681 30,885 (697)
9,127 2,858 486 220 543 13,234 (492)
27,640
1,216
1,332
30,188
12,742
Total for 2017
10,659
1,009
1,074
12,742
(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
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
2018 Aggregate amount paid £000
2017 Aggregate amount paid £000
13,805 13,807 28 27,640
3,005 7,688 (34) 10,659
1,216 28,856
1,009 11,668
The £28.856m 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.
44
Grants paid to individuals
3.3
No grants were paid to individuals in 2017/18 or 2016/17.
Auditor’s remuneration
3.4
In 2017/18, the external auditor was paid £51,600 (inclusive of VAT) in respect of the audit of statutory accounts (£50,280 in 2016/17). Additional costs for assurance services and tax advice for the financial year to March 2018 were £nil and £17,700, respectively (£nil and £720, respectively, in 2016/17).
Annual Report 2017/18
bartscharity.org.uk
Expenditure, including support costs
3.5
Cost of raising funds Fundraising £000
Investment management Financial Property £000 £000
Charitable activity £000
2018 Total £000
2017 Total £000
Direct costs
143
1,735
528
28,856
31,262
13,940
Salary costs Apportionment of other overheads Total support costs
531
83
104
852
1,570
1,470
337 868
45 128
57 161
480 1,332
919 2,489
707 2,177
Total resources expended 2018
1,011
1,863
689
30,188
33,751
16,117
Direct costs Salary costs Apportionment of other overheads Total support costs
85 534
1,562 95
625 108
11,668 733
13,940 1,470
273 807
43 138
50 158
341 1,074
707 2,177
Total resources expended 2017
892
1,700
783
12,742
16,117
Where possible, costs have been directly allocated to one of the above categories. Of total overheads, 65% were allocated in this manner for 2017/18 (69% in 2016/17). The remainder, relating to general office costs, has been allocated on the basis of staff time. Support costs include governance costs of £147,915 (£129,098 in 2016/17). Restricted expenditure amounted to £3.03m in 2017/18 (£3.04m in 2016/17). Analysis of staff costs
4.1
Salaries and wages Social security costs Other pension costs Total Average monthly number of full-time equivalents Average head count
2018 Total £000
2017 Total £000
1,315 144 111 1,570
1,239 139 92 1,470
28 29
26 27
Staff costs include restructuring costs of £29,070 (£33,150 in 2016/17). Pension 4.2 contributions for higher paid employees
The following pension contributions were made for employees within the annual emolument ranges indicated: Value of Number contributions of staff £000 receiving £ contributions 70,001 to 80,000 80,001 to 90,000 140,001 to 150,000
bartscharity.org.uk
10 26 13
1 3 1
Annual Report 2017/18
45
Accounts Notes to the accounts Higher paid employees
4.3
The following number of employees received annual emoluments falling within the ranges indicated: £ 60,001 70,001 80,001 120,001 140,001
to 70,000 to 80,000 to 90,000 to 130,000 to 150,000
2018
2017
0 1 3 0 1
1 2 1 1 0
Key management personnel (the senior management team of the charity) received aggregate employee benefits of £538,597 in 2017/18 (£583,301 in 2016/17). Fixed assets
5
Fixed assets: Tangible and intangible
Tangible and intangible fixed assets: Balance at 31 March 2017 Additions Write off Balance at 31 March 2018 Accumulated depreciation: Balance at 31 March 2017 Charge for the year Write off Balance at 31 March 2018 Net book value at: 31 March 2018 31 March 2017
Heritage assets
6
Freehold land and buildings £000
Fixtures, fittings and equipment £000
Intangible assets
Total
£000
£000
0 0 0 0
239 111 (238) 112
251 60 0 311
490 171 (238) 423
0 0 0 0
221 15 (221) 15
115 97 0 212
336 112 (221) 227
0
97
99
196
0
18
136
154
2018 £000
2017 £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
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).
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Annual Report 2017/18
bartscharity.org.uk
Analysis of fixed asset investments
Investments
7.1
7.2
Fixed asset investments
Property
Financial
2018 Total
2017 Total
£000
£000
£000
£000
Market value at 1 April 2017 Less: Disposals at carrying value Add: Acquisitions at cost Net gain/(loss) on revaluation Market value at 31 March 2018
135,830 (17,550) 366 1,903 120,549
303,249 (14,901) 27,398 (29) 315,717
439,079 (32,451) 27,764 1,874 436,266
383,328 (42,996) 41,690 57,057 439,079
Cash held as part of the investment portfolio Total
0 120,549
177 315,894
177 436,443
496 439,575
Market value at 31 March:
Investment properties Investments listed on stock exchange Cash held as part of the investment portfolio Alternative investments Total
2018 Total £000
2017 Total £000
120,549 285,851 177 29,866 436,443
135,830 276,146 496 27,103 439,575
Financial investments held at 31 March 2018 include 16 unit trust funds, representing 91% of the total value, and 16 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
2018 Total £000
2017 Total £000
6,249 9,138
6,009 7,698
8 15,395
8 13,715
Accounting for lease incentives increased investment property income by £202,000 in 2017/18 (£161,000 in 2016/17); see note 1.4. Restricted investment income amounted to £763,000 in 2017/18 (£691,000 in 2016/17).
bartscharity.org.uk
Annual Report 2017/18
47
Accounts Notes to the accounts Analysis of debtors
8.1
Amounts falling due within one year as at 31 March:
Trade debtors Prepayments Accrued income Other debtors Total
2018 £000
2017 £000
1,417 193 3,035 29 4,674
995 154 3,369 206 4,724
Accrued income relates to income on financial investments and amortisation of rent-free period for related leases (see note 1.4).
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:
2018
Not later than one year Later than one year and not later than five years Later than five years Total
2017
£000
£000
5,823 17,987 24,945 48,755
5,078 15,232 27,034 47,344
Future minimum lease payments include £26.0m from a 45-year lease, granted in December 2014.
Analysis of creditors
9.1
Amounts falling due within one year as at 31 March: Trade creditors Other creditors Grant accruals Deferred income Total
2018 £000
2017 £000
1,473 222 23,022 1,268 25,985
1,291 433 18,449 1,328 21,501
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 FY2017/18.
9.2
Total creditors falling due after more than one year as at 31 March: Grant accruals Total
2018 £000
2017 £000
27,040 27,040
16,653 16,653
There are no grants payable whose values require subjective estimation and therefore no provisions have been included in this set of accounts.
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Annual Report 2017/18
bartscharity.org.uk
Analysis of funds
10.1
Endowment 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 2017 £000
Gains and losses £000
Balance 31 March 2018 £000
274,291
1,924
276,215
6,762 2,452 2,014 1,772 793 590 249 247 244 211 954 290,579
30 11 9 8 4 3 1 1 1 1 3 1,996
6,792 2,463 2,023 1,780 797 593 250 248 245 212 957 292,575
Note 1.3 on page 41 provides further details of the endowment fund structure. There were no other resources received, expended or transferred in FY2017/18. Investment gains on endowment funds amounted to £2.0m for 2017/18 (£39.3m in FY2016/17).
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 2017/18
49
Accounts Notes to the accounts 10.2 Restricted funds
Material funds JJ Guthrie Blandford and George Shuter Staff Benefit Irritable Bowel Disease Research Margaret Centre Cardiac fund Tallerman Research Fund Legacy Gastroenterology Whipps Cross Funds £400k–£500k (1) Funds £300k–£400k (8) Funds £200k–£300k (8) Funds £100k–£200k (23) Others (551) Total
Balance 31 March 2017 £000
Incoming resources
Resources expended
£000
£000
2,019 304 1,217 476
86 1,263 117 291
808 636
17 11
519 2,048 1,829 3,014 7,357 20,227
17 901 279 295 1,375 4,652
(339) (83) (115) 85 0 0 (39) (111) (187) (204) (2,034) (3,027)
Gains and losses £000
Transfers between funds £000
Balance 31 March 2018 £000
10 0 0 0
0 0 0 46
1,776 1,484 1,219 898
0 0
0 (2)
825 645
0 0 0 0 0 10
0 1 9 (6) (45) 3
497 2,839 1,930 3,099 6,653 21,865
Note 1.3 on page 41 provides further details of the restricted fund structure. Investment gains on restricted funds amounted to £10,000 in FY2017/18 (£422,000 in FY2016/17).
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Annual Report 2017/18
Details of material funds Name of fund
Nature and purpose of each fund
JJ Guthrie Blandford and George Shuter Staff Benefit Irritable Bowel Disease Research Margaret Centre Cardiac fund Tallerman Research Fund Legacy Gastroenterology Whipps Cross
Staff benefit Research into irritable bowel disease Margaret Centre at Whipps Cross University Hospital Treatment of and research into cardiac disease Facilitates research into children’s diseases Gastroenterology department at Whipps Cross
bartscharity.org.uk
10.3
Designated funds
Material funds Whipps Cross general fund HF Bailey City and Hackney Cardiac fund Funds up to £100k (9) Total
Notes to the Cash Flow Statement
11.1
Balance 31 March 2017 £000
Incoming resources
Resources expended £000
Transfers between funds £000
Balance 31 March 2018 £000
£000
182 157 122 346 807
60 0 0 0 60
(111) 0 0 (9) (120)
0 0 0 (1) (1)
131 157 122 336 746
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
Net cash used in operating activities
Net (expenditure)/income for the period Adjustments for: (Gains) losses on revaluation and disposal of investment assets Tangible fixed assets written off Investment income Depreciation charges Decrease/(increase) in debtors Increase/(decrease) in creditors Cash (outflow)/inflow from operating activities
11.2
Analysis of changes in cash and cash equivalents
Cash in hand and at bank Total cash and cash equivalents
Events after the 12 end of the reporting period
bartscharity.org.uk
Balance 2017 £000 985 985
2018 £000
2017 £000
(10,976)
59,497
(3,155) 17 (15,395) 112 724 14,888 (13,785)
(58,239) 0 (13,715) 92 (805) (1,594) (14,764)
Movement £000
Balance 2018 £000
7,035 7,035
8,020 8,020
An investment property was sold in June 2018 for £12.15m. The property is included within financial investments as at 31 March 2018 (note 7.1).
Annual Report 2017/18
51
Accounts Notes to the accounts Trustee 13.1 and connected persons transactions 13.2
Trustee expenses reimbursed No Trustees were reimbursed for any expenses in 2017/18 (£550 to two Trustees in 2016/17). Trustee remuneration No Trustee received remuneration in 2017/18 or 2016/17.
13.3
Details of transactions with Trustees or connected persons There were no transactions with the Trustees or connected persons in either 2017/18 or 2016/17.
13.4
Trustee indemnity insurance £
Year ended 31 March 2018 £
Year ended 31 March 2017
1,265
1,259
Premiums paid by Barts Charity during the reporting period
Loans or 14 guarantees secured against assets
There were no such loans or guarantees for Barts Charity in 2017/18 or 2016/17.
Connected organisations
15
There were no connected organisations of Barts Charity in 2017/18 or 2016/17.
Related party transactions
16
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. The total amount of related party transactions made without conditions was £5,305 (£5,000 in 2016/17).
During the year, Barts Charity made revenue and capital grants totalling £13.8m and £13.8m 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.
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Annual Report 2017/18
bartscharity.org.uk
P 26
Support Barts Charity There are many ways in which you can help, either as an individual or organisation:
Support us with a regular gift or a one-off donation 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
P 23
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, pp. 1, 2 (lower), 3, 4, 6, 7, 8 (upper left), 9, 10, 11, 12, 13, 14, 16, 17, 18 (lower), 20, 21, 22, 23, 24, 25 (lower), 28, 29, 31, 32: Noel Murphy; pp 1 (right, centre), 8, 15 (top right): Barts and The London School of Medicine and Dentistry; p. 2 (upper): Ian Jones; p. 5: iStock/Getty Images; p. 18 (upper): Shutterstock; p. 25: iStock/Getty Images; p. 27 (upper): courtesy Aspen UK.
P 16
Text and project management: Ian Jones, Jinja Publishing Ltd. Design and production: Fountainhead Creative Consultants.
Annual Report 2018
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 2018
Barts Charity
