Annual Report and Financial Statements 2015 Ex-Services Mental Welfare Society Company registered in England and Wales No 256353, Charity No 206002, Charity Scotland No SC038828
Annual report 2015
03
The facts
For every £1 we spend:
81p is spent on Veteran treatment and support
16p
We are currently supporting 971 Veterans of the Afghanistan conflict and 1,185 from the Iraq conflict
6,004 Veterans are currently being supported, up from 5,400 last year New referrals have risen by 26% this year
is spent on fundraising
Veterans are seeking help earlier:
2p
Veterans of Afghanistan on average seek treatment 2.1 years after leaving Service
is spent on raising awareness, improving access and tackling stigma
Veterans of Iraq on average seek treatment 4.4 years after leaving Service From all conflicts, the average is
1p is spent on governance
Fundraising For every £1 we spend on fundraising we bring in
£4
13.1 years
1,366 Veterans were discharged during 2014/15 We undertook a two year study into our PTSD Intensive Treatment Programme:
94% completed the programme
87%
reported a significant reduction in their symptoms and results were maintained at six months
Raising awareness 95th Anniversary generated over 900 pieces of media coverage
1,083 LinkedIn followers (up 130%) 26,000 Twitter followers (up 44%) 47,000 ‘likes’ on Facebook (up 59%) Combat Stress Annual Report and Financial Statements 2015
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Contents 05
Introduction
06
Vision, Mission, Values and Aims
07 Strategic Report
Combat Stress Tyrwhitt House, Oaklawn Road, Leatherhead, Surrey KT22 0BX General enquiries: 01372 587 000 Email: contactus@ combatstress. org.uk Website: combatstress.org.uk Facebook: facebook.com/ CombatStress Twitter: @CombatStress You Tube: Search for Combat Stress Charity LinkedIn: Search for Combat Stress Ex-Services Mental Welfare Society Company registered in England and Wales No 256353, Charity No 206002, Charity Scotland No SC038828
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Review of 2014/15
07
Developing integrated Community and Outreach, Outpatient and Inpatient Services
13
Improving the evidence base of therapeutic practice
15
Sustaining our financial base
17
Developing an appropriate brand and image to deliver excellence
19
Plans for the future
23
Financial review
25
Principal risks and uncertainties
26
Our employees
26
Public benefit, policies and governance
28
Statement of Trustees’ responsibilities
29 Auditor’s Report 29
Independent auditor’s report to the Members
31
Financial Statements
31
Consolidated Statement of Financial Activities
32
Consolidated and Charity Balance Sheets
33
Consolidated Cash Flow Statement
34
Notes to the Financial Statements
50 Legal and Administrative Information
Annual Report and Financial Statements 2015 Combat Stress
05
Introduction Welcome from the Chair of Trustees and the Chief Executive
T
he last year was one of conflicting emotions – relief as the last UK operational troops finally withdrew from Afghanistan, remembrance as the Poppies at the Tower of London helped the nation remember those who gave their lives 100 years ago in the First World War, and celebration of the 95 years that Combat Stress has been providing care for exservicemen and servicewomen . Over those 95 years Combat Stress has continually adapted the support offered in order to meet the changing needs and expectations of Veterans. This last year has seen new residential programmes backed up by changes to the model of work carried out in the community, which will improve access and reduce waiting times. We are working more collaboratively with the NHS, other charities and providers than ever before. With our partners, we have been able to improve our systems and processes to ensure the recovery pathway we offer supports Veterans through the highs and lows of their emotional journey to recovery. Our Patron, HRH the Prince of Wales, is consistently generous with his time and we were both honoured and extremely grateful when in June 2014 he hosted a reception for us at St James’s Palace to mark our 95th birthday. Similarly, we and the Veterans were thrilled when HRH Prince Harry visited Tyrwhitt House in March 2015 for a private visit. These events coupled with the Invictus Games in September 2014 shone a spotlight on the former Armed Forces personnel we support who, having given so much, still need our long-term help. Combat Stress will continue to develop and be at the forefront of all those who campaign for the best possible treatment for Veterans who suffer mental ill health as a result of their Service. Unfortunately, the mental health outcomes of recent operational deployments are likely to affect the Veteran community for many years to come.
HRH Prince Harry made a private visit to Tyrwhitt House in March
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Vision, Mission, Values and Aims Our Vision That Veterans will be able to live free from the harmful effects of psychological wounds.
Our Mission To provide timely, effective clinical treatment and welfare support to Veterans who suffer from psychological wounds. To realise this we must: • Be accessible to those who need help • Be expert at what we do and be recognised as such • Work in partnership with others • Raise awareness of Veterans’ needs
Our Values • Putting Veterans at the centre of our work • Aspiring to achieve excellence in everything we do • Fostering a culture of respect and integrity
Annual Report and Financial Statements 2015 Combat Stress
Our Strategic Aims From 2012 to 2017 we are focused on the strategic aims below: 1 Developing integrated Community and Outreach, Outpatient and Inpatient services 2 Improving the evidence base of therapeutic practice 3 Sustaining our financial base 4 Developing an appropriate brand and image culture to deliver excellence Through these aims we have developed our services to respond to the changing needs of Veterans and increased demand for our help.
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Strategic Report Review of 2014/15
and has resulted in them seeking our help earlier. Despite this, the average time from leaving military service to contacting us was 13.1 years, but for those who served in Afghanistan and Iraq the average time was just 2.1 years and 4.4 years respectively. By the end of 2013 we saw a 57% increase in the number of referrals from Veterans who have served in Afghanistan. This increased demand led us to carry out a review of our Community and Outreach services to increase accessibility, reduce waiting times and increase the focus on recovery.Recommendations from the review are being implemented
Veterans supported during the year This year has seen a marked increase in the number of Veterans seeking help with new referrals to our services up 26%, the largest increase in our history. Our work over recent years has helped reduce the stigma associated with Veterans’ mental health issues. This, together with our commitment to work with partners to develop an effective ‘whole system’ approach, has increased awareness of Combat Stress among Veterans at large
new referrals per financial year 2500
2328 1303 1160
2000
1854
1500 1706
1257
1443
945 1500
and the new community service will be launched on 1 October 2015. Our treatment programmes are creating new possibilities and hope of recovery for Veterans and their families, and during 2014/15 a total of 1,336 Veterans were discharged, compared to 1,086 in 2013/14.
Developing integrated Community and Outreach, Outpatient and Inpatient services referral Most Veterans make initial contact with Combat Stress themselves, and over the last year 52% of referrals were directly from the Veteran while 19% were as a result of calls to the Combat Stress 24Hour Helpline.
995 1000
759
New Veteran referrals up by
500
0 2005 2006 2007 2008 2009
2010
2011
2012
2013
2014
2015
26%
on previous year
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52%
Top 10 Referral Sources 2014/15 key % Service welfare 4 organisation
of Veterans refer themselves for treatment
3% SSAFA War pension 4% service 3% Website
In order to increase accessibility for Veterans, it is vital we continue to increase awareness of the treatment we offer. We are collaborating with The Royal British Legion to deliver community services from their high street ‘Pop-in centres’ across the UK. Veterans will access these centres for assessment, psycho-education and occupational therapy. We have a Welfare Officer working at Tedworth House Recovery Centre, in partnership with Help for Heroes. We have launched a pilot project in partnership with Leicestershire Police to identify Veterans at the point of entry into the criminal justice system, allowing us to fast-track them into appropriate treatment.
Our Community Services Assessment and diagnosis The first step for Veterans who need our support is usually an initial assessment from one of our Regional Welfare Officers (RWOs). If a clinical need is identified, Veterans will be referred for a clinical assessment by a Community Psychiatric Nurse. From this assessment an individual treatment plan can be developed.
Community 6% mental health team 4% GP/Consultant 19% Helpline 3% Relatives The Royal 2% British Legion 52% Self
There are 15 Community and Outreach Teams across the UK. Each team includes a welfare officer who has a military background, which for many Veterans greatly helps facilitate their engagement with our services. Our clinicians work closely with our RWOs to ensure a person-centred approach. Our treatment framework focuses on the goal of recovery from the very start. The core of our treatment model is ‘strengths-based’, aiming to optimise resilience (the capacity to withstand stress and catastrophe) within a culture of hope and possibility. To increase accessibility and promote recovery and community reintegration, we are moving towards a ‘hub and spoke’ model operating from The Royal British Legion high street ‘Pop-in centres’, from October 2015. This follows a
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comprehensive year-long review of our current community service. During 2014/15 we ran a successful pilot programme delivering some of our community services from these centres. Occupational therapists have been introduced into some Community Teams. Occupational therapists identify and optimise characteristics, building a Veteran’s abilities and inner resources.
Pilot Substance Misuse Case Management Programme During 2014/15 we ran a pilot scheme for Veterans who had substance misuse difficulties, and who may also have underlying mental health issues. The case management service works closely with local voluntary and statutory substance misuse services in England and Scotland, offering screening and brief interventions.
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6,004
There were 6,004 Veterans actively receiving our support or treatment at 31 March 2015
We also offer training on Veterans’ specialist needs to other services. We aim to attract and engage Veterans who are new to treatment and to reduce drop-out between the services a Veteran may need to access. The programme is now running in Wiltshire, Glasgow and Newcastle. We have new staff in the Forth Valley and are planning to offer the service in Portsmouth and Manchester.
Reserve Forces Liaison Team We have a dedicated team that understands the specific mental health needs of the UK Reserve Forces. These liaison personnel work directly with Reservists and in partnership with military staff and clinical professionals. They also work with employers and others to raise awareness of mental health issues in the Reserve Forces so that more who need our help come forward.
Pilot peer support programme A new initiative is underway to introduce structured peer support. We are currently working with Mindspace in Perth where four of our Veterans are on target to complete a 26-week training course resulting in an accredited mental health peer mentoring qualification. Next year will focus on the use of such peer supporters across all of our community services.
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‘Camel Train Helmand Valley’ by Clement Boland was displayed at Guildford Cathedral as part of an Armed Forces Day exhibition
Residential Services At our three specialist treatment centres in Ayrshire, Shropshire and Surrey, We provide clinical assessment and treatment through integrated programmes based on Cognitive Behavioural Therapy and Occupational Therapy, depending on the Veterans’ individual needs. The treatment centres provide an environment that is sensitive to military culture. Our highly trained team includes psychiatrists, psychologists, cognitive behavioural therapists,
37%
occupational therapists, art therapists, mental health nurses and recovery support workers who deliver evidence-based treatment according to the Veteran’s presenting needs. Details of the positive outcomes achieved on our PTSD Intensive Treatment Programme are in the section ‘Improving the evidence base of therapeutic practice’ on page 13. In September 2014 we increased the residential capacity at Audley Court to 29 beds with the addition of a new wing,
increase in calls to our 24-Hour Helpline
Annual Report and Financial Statements 2015 Combat Stress
which includes two bedroom and bathroom suites that are fully equipped for disabled use. Bed occupancy rates have improved during the last year with occupancy rates of 77% on average against a target of 85%. This is an improvement of nearly 15% on the previous year. We aim to increase this further in the forthcoming year with the introduction of a national programme delivery plan. Sometimes the cost of travelling to our centres means Veterans find it difficult to attend the programmes. We have introduced a rail pass scheme, sponsored by Virgin Trains, which will help to alleviate this problem. Virgin Trains’ support equates to £40k.
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Art Therapy Art Therapy has been introduced across our three treatment centres and is an integral part of all of our treatment programmes. Individual art therapy sessions are available to Veterans on a residential programme. We are currently piloting individual art therapy on an outpatient basis at Tyrwhitt House.
PTSD Intensive Treatment Programme This residential programme provides treatment for those suffering with the complex symptoms of post-traumatic stress disorder, accompanied by other mental health problems. We completed 808 assessments for the programme during 2014/15 with 530 follow-up assessments. 274 Veterans started the programme and a total of 249 completed. Only four who had planned to start did not attend.
Transdiagnostic Programme The Transdiagnostic Programme can be accessed by a Veteran with any diagnosis, at any time. It is a CBT skills-focused groupwork programme combined with individual sessions and a bespoke treatment plan. The programme provides Veterans with techniques to manage symptoms that affect their quality of life, whatever their diagnosis. Individual treatment works with the group sessions to ensure the Veteran is able to discuss current issues and, using the skills learned in the groups, find alternative
ways of coping with a variety of problems. It is a clinically flexible programme that enables Veterans to be admitted for a duration of between one and two weeks, based on individual need.
Stabilisation Programme The Stabilisation Programme ensures Veterans are stable enough to gain maximum benefit from other programmes at Combat Stress or in the community. It is often identified at initial assessment that many Veterans have difficulty managing their intense emotion. The programme focuses on emotional regulation and combines oneto-one therapy with psychoeducational group sessions using cognitive skills and corresponding interventions to enable the Veteran to engage in future treatment. This programme is two weeks in duration.
Anger Management Inappropriate anger is prevalent in the Veteran population, particularly amongst those with a diagnosis of PTSD. The Anger Management Programme uses cognitive behavioural therapy to explore the links between thoughts, feelings, physiological responses and behaviour. It enables Veterans to positively manage their anger, using a range of effective strategies such as relaxation, mindfulness and distress-tolerance skills. The programme combines one-to-one therapy with psycho-educational group work. The approach
taken is a practical one, with an emphasis on building new skills and addressing multiple contributors to problematic anger, including the effects of having been in combat. The programme is two weeks in duration.
Recovery and Resilience Programme Our Recovery and Resilience Programme is fully integrated into all of our residential treatment programmes. The programme takes a structured occupational therapy approach to increase engagement in meaningful activity and includes employment mentoring, life-skills workshops and social activities in the community.
Outpatient Services Our outpatient services are focused on assessment, diagnosis and effective treatment within the recovery framework. This year has seen an increase in ‘remote’ outpatient clinics, with psychiatrists and psychologists delivering outpatient services from a number of community locations including Belfast, Manchester, Colchester, Glasgow and the South West. A remote clinic in Newcastle is due to begin in the near future.
57% Increase in referrals for Veterans of Afghanistan
Combat Stress Annual Report and Financial Statements 2015
annual report 2015 Combat Stress was honoured to be a charity partner in the Tower of London’s thought-provoking art installation marking the centenary of the First World War
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87%
reported a significant reduction in PTSD symptoms and results were maintained after six months
Helpline Every minute of every day, our Helpline is available to the whole military community, including serving personnel, members of the UK Reserve Forces and their families. Professional, trained staff listen and give support on Service-related mental health issues. Advisors direct callers to our support workers or refer them on to another organisation for specialist help. The Helpline is delivered by the mental health charity Rethink Mental Illness. During 2014/15 the number of contacts to the Helpline increased by 37% to 11,807. This included 2,347 new users to the service. The highest increase in callers was within the age range 46-55. There was a fall in the number of general enquiries, which indicates that more Veterans know about our service and are not simply wanting to understand more about it. During 2014/15 we focused on improving our answer times and continuing to provide comprehensive training for those handling the calls.
RECOVERY BREAKS AT Rehabilitation Centres Our Recovery Breaks are delivered in partnership with The Royal British Legion and are accessed towards the end of the recovery pathway. The focus of this structured occupational therapy programme is on community reintegration and skills implementation.
Improving the evidence base of therapeutic practice As a clinically-led organisation dealing solely with Veterans’ mental health, we attach a great deal of importance to the contribution we can make to the development of best practice, as well as the achievement of positive outcomes in the treatment of trauma injuries and other mental health issues suffered by ex-members of the Armed Forces. As the largest charity in the United Kingdom specialising solely in Veterans’ mental health, we are in a unique position to conduct and contribute to research. This year we appointed a lead psychologist from King’s Centre for Military Health Research, King’s College London, to lead our research, formally assess treatment outcomes and to disseminate the results. Our research projects are aimed at publication in peer-reviewed journals and also sponsored
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students doing relevant Masters and Doctorate degrees. Two studies have been published this year, the first entitled ‘PTSD, stigma and barriers to help-seeking within the UK Armed Forces’ and the other on our treatment outcomes following the PTSD Intensive Treatment Programme. This second paper, published in the British Medical Journal Open, focused on 246 Veterans who accessed the PTSD Intensive Treatment Programme between late 2012 and early 2014. They were followed up at six weeks and six months following treatment and showed a very high engagement and a completion rate of 94% in contrast to American studies which have dropout rates of 22% to 46%. The study also identified reductions in PTSD scores following treatment. 87% reported significant reductions in their symptoms, with reduced anxiety, depression,
alcohol misuse and anger. Results were maintained at each followup six months later. Among the benefits of treatment were an improved ability to work and manage home activities, improved social activities, improved social and leisure activities and improved relationships. We have also submitted two other papers, one concerning ‘Brain injury and post-traumatic stress in our Veterans’, and one that predicts treatment outcomes in relation to Veterans’ clinical presentation patterns. Our research and the outcomes from our treatments contribute to the body of global clinical evidence, which improves understanding of both Veterans’ mental health problems and effective treatment options. We continue to collect data for all our treatment programmes, both in the community and
residential, and these will form the basis of future research.
Development of systems Our ability to record complete data accurately and diligently is of critical importance in analysing and improving our treatment outcomes. Our funders gain confidence in our treatment programmes as we are able to demonstrate their effectiveness and the real improvement they make in Veterans’ mental health. However, it does take time to gather data and produce an evidence base, and we have been improving the methods of collecting this data over the last financial year. We have also invested significant funds in the design and configuration of a new Patient Administration System (PAS) and digitising our clinical records. This will help our clinical therapists and nurses retrieve and store Veterans’ data and records more efficiently and will also help us collect data more easily, both on what we’re doing and how well we are doing it. This new system will be implemented by the end of 2015. We have appointed a Health Records Officer to catalogue our archive files and to assist with the digitisation of current records.
£4 Hollybush House Veterans with a poppy from ‘Blood Swept Lands and Seas of Red’
Annual Report and Financial Statements 2015 Combat Stress
For every £1 we spend on fundraising, we raise £4
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Sustaining our financial base During 2014/15 we carried out a review of our fundraising and subsequently prepared a new fundraising strategy to take us through to our centenary in 2019. More details are included in our future plans for fundraising on page 20. In common with many other charities, we have recognised the need to invest more in our fundraising efforts during recent years when the economic environment of recession and public spending cuts have led to reductions in income for the public, for companies and for charities. While we have seen reductions in some income sources in 2014/15 we have also seen positive indications there may be better times ahead, and we continue to view our plans for delivery of enhanced services to Veterans as achievable. Throughout 2014/15 we delivered a series of appeals and increased our number of active supporters by more than 40% to reach some 30,000 people. We also improved our online donation processes to facilitate multi-channel fundraising. More people now give via the website and social media – we have seen a 25% increase in online donations. We are very grateful to the many people who have remembered Combat Stress in their wills and have left a legacy for our treatment of Veterans. Income from legacies grew by 10% to £1.86m in 2014/15
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(2013/14: £1.69m) and we plan to expand our legacy-giving programme in the hope that others will leave a bequest to Combat Stress for the future. We launched the Forces Lottery and by the end of the financial year we had attracted more than 3,345 supporters to play every week. We plan to attend more events to sell tickets during 2015/16 so that we can build this new source of income further. The five annual Battle Proms concerts raised the highest figure to date for Combat Stress in 2014 bringing in a total of £25,710. In addition, Combat Stress was one of the beneficiary charities of the event ‘Heroes at Highclere Castle’. We were very pleased to be nominated as the charity for the Sunday Express Christmas Appeal, which not only raised £6,000, but also served to raise awareness among the general public of military mental health in a year when British troops withdrew from Afghanistan. Our Veterans and staff contributed to the BBC’s Comic Relief Great British Bake Off, which provided great press and media opportunities. Paul Hollywood visited our Tyrwhitt House treatment centre to help the Veterans bake cakes and subsequently our Twitter engagement doubled in March. In October 2014, we benefited from the proceeds from Wincanton Charity Race Day totalling £50,000. Our Scottish lectures sold out in 2014. Kate Adie gave a talk on ‘Women in the First World War’ and Neil Oliver, an archaeologist,
30,000
30,000 active supporters, up 40% on last year
historian and broadcaster gave a talk at Craiglockhart Campus, on Australia’s Great War and attitudes to PTSD. Writer and broadcaster Martin Bell OBE presented our Armistice Lecture, reflecting on the centenary of the Great War and his 50-year career across the ‘unquiet corners of the world’. Green Light Limited has also supported Combat Stress by successfully launching a recycling scheme across many military bases in the UK.
Historic Royal Palaces installation – Blood Swept Lands and Seas of Red Combat Stress was privileged to be a charity partner in the Tower of London’s thoughtprovoking installation marking the centenary of the First World War. Blood Swept Lands and Seas of Red at the Tower of London, created by artists Paul Cummins and Tom Piper, featured a total of 888,246 ceramic poppies, each one representing a British military fatality. All the poppies created for ‘Tower of London Remembers’ were sold with the proceeds shared equally amongst six service charities, of which Combat Stress was a selected charity, to recognise the vital work we do.
We received £1.4m in donations and royalties from this event in 2014/15 and we are very grateful to Historic Royal Palaces, to the artists and to the general public who purchased a poppy and made donations. We are supported by a number of extraordinary people who do extraordinary things for us – gruelling runs, walks and other challenges to raise vital funds for our treatment of Veterans. Their efforts are very much appreciated and recognised and we hope they will continue their valiant pursuits as the need for our services is increasing.
Developing an appropriate brand and image to deliver excellence One of our aims is to make Combat Stress more approachable through the visibility of our brand, vision, mission and values so Veterans come to us faster and stay with their recovery programmes until they and their families are again living fulfilling lives. We have raised our profile considerably over the last year and we are the first point of
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Our 95th anniversary generated over
call for all journalists seeking comment on the mental health of UK Veterans. During 2014/15 we developed a communications strategy that will form the backbone for all our communications, marketing and public relations in the coming years, as we approach our own centenary. Our focus is very much on accompanying Veterans through their whole journey towards recovery. We celebrated our 95th anniversary with a Royal Garden Party at St James’s Palace, and this provided an opportunity to demonstrate our long history and expertise in Veteran mental health and celebrate our successes. Another outcome of the anniversary was substantial media coverage leading to more than 900 pieces on Sky News, BBC radio and TV, ITN, Channel 4 and national and regional press. During the year we updated and strengthened our social media presence. The recruitment of a new Digital Officer helped us improve the interactivity between Combat Stress and our supporters and improved signposting for Veterans. The result was that we saw a 44% increase in followers on Twitter to 26,700 and over 47,000 ‘likes’ on Facebook, an increase of 59%.
900
pieces of media coverage
Annual Report and Financial Statements 2015 Combat Stress
We also contributed more effectively and professionally to high profile media opportunities and presented a coherent and consistent message. We ran several campaigns during the year, including ‘Luke’s War’, which raised awareness of how mental health issues affect Veterans’ families. Bonfire Night often sees an increase in calls to the 24-hour Helpline, as fireworks can trigger flashbacks and lead to anxiety. We created a toolkit to support Veterans which was posted on our website news page and was shared across social media. The post reached over 170,000 people on Facebook and Twitter. In March 2015, we held the first business symposium to highlight specialist support for Veterans and Reservists in the workforce. Experts from the Department of Health, Ministry of Defence and the corporate sector joined clinical specialists from Combat Stress to explain the opportunities and challenges for businesses with employees who have served in the Armed Forces. The event was sponsored by Thales and was very well attended. We will repeat the event next year and are looking at the possibility of holding a similar event in Scotland.
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Plans for the future Perhaps our greatest challenge for the future rests with the increase in the numbers coming forward for help. The 26% increase we have seen over the last year seems likely to be a feature of the next few years, and we will need to be in a position of organisational and economic strength if we are to avoid long waiting lists or, in the worst case, Veterans reaching crisis as they seek the help they need.
Developing integrated Community and Outreach, Outpatient and Inpatient Services During the coming year we plan to continue improving the integration of our community, residential and outpatient services and to further develop our treatment programmes. Current programmes in the treatment centres will be strengthened, others may be simplified and migrated to the community hubs and spokes. Our new Patient Administration System is a major project that will come to fruition in 2015. We will train our clinical and welfare teams in the use of the system while continuing to deliver treatment and other services to Veterans. This will be challenging for all staff as they
become familiar with new processes and software. However, it will deliver tangible benefits as digital records will be more easily and efficiently accessed, assessments and other data will be more effectively stored, analysed, monitored and reported on, and our outcomes will be able to be collated more easily. Integration of our services is key to our performance, and this system will enable us to access a Veteran’s complete record which will be available to all clinical and welfare staff, whether in a treatment centre or working in a Veteran’s own home. We will complete our review and revision of our Community services to more Veterans near to where they live. This will include increasing the number of psychiatrists and psychotherapists in the community. We will review whether lower intensity treatment centre services can be delivered by the Community Teams to improve accessibility and give Veterans more choice. Our six-week PTSD Intensive Treatment Programme is currently funded in England from a five-year contract with the NHS, which ends in March 2016. We believe it is essential this Treatment Programme continues to be available for Veterans. We will recruit staff to enable us to launch the Substance Misuse Case Management Programme
47,000 We now have more than 47,000 ‘likes’ on Facebook, an increase of 59%
in 2015/16 in Portsmouth, Forth Valley and Manchester. We will research and review all of our existing and potential partnership arrangements to strengthen connections between healthcare providers and provide continuity throughout the whole Veteran care pathway. Internally we will be developing an Intranet to improve internal communication and crossfunctional working.
Improving the evidence base of therapeutic practice The first part of this report details the research and evidential work the Charity was doing during the last year. We are looking at other areas of research, including barriers to self-referral, referral patterns over the last 25 years and, most importantly, why we have had a 26% rise in new referrals for Veterans coming for help in the last financial year. In particular, we see that Veterans who fought in Afghanistan and Iraq are continuing to come much earlier than expected, seeking support 2.1 years and 4.4 years respectively after leaving the military. This is in sharp contrast to all other veterans, who wait an average of 13.1 years before coming to us for help. An important question is whether or not this trend will continue. At 31 March 2015 we had 1,198 Iraq veterans and 984 Afghanistan Veterans accessing treatment. We are now looking at referral patterns over the last 25 years and seeing whether or not these patterns can help us to project the
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numbers of Veterans that will come forward in the next few years. We hope to publish these findings. We plan to evaluate the outcomes and value of the Helpline and review whether we can improve the service. We will need to secure further funding for the Helpline as the current funding ends in March 2016. We will continue to collect evidence of the effectiveness of services delivered within the community and treatment centres and will publish the results at relevant points.
Sustaining our financial base We will expand our fundraising in line with our new fundraising strategy. The strategy sets out clear goals for providing increased capability and capacity to support the hundreds of volunteers that organise events and raise funds for Combat Stress across the UK. We will be recruiting fundraisers in regions to provide local contacts and co-ordination for our supporters to help them maximise local fundraising opportunities and raise more sponsorship and donations, while also raising awareness of our services for Veterans. We plan to improve the digital solutions currently available for supporters who donate via online giving and who purchase tickets and merchandise from our online shop. We are very aware that our website currently does not work well when accessed from mobile devices and this will be addressed during 2015/16. Our income from major and corporate donors reduced during
2014/15, in part due to changes in our staffing but also due to the continuing climate of austerity. However, the indicators are that economic confidence is returning and we are hopeful more donors will be willing to pledge donations to assist with our work. During 2015/16 we will develop an effective major donor programme to engage with high net worth individuals. We will provide opportunities to fund specific activities or treatments in a region that is local to the donor and will provide regular updates and outcomes for these activities. A corporate advisory board has been set up with the aim of increasing corporate partnership opportunities. This group consists of a number of business representatives who support the work Combat Stress does and who will actively engage with other companies to explore how and when businesses can provide the funding or expertise for our projects and various treatment programmes. We will also be appealing to the serving members of the Forces to support those who have previously served and are now struggling with day-to -day living. Many individuals are generous enough to leave a legacy to Combat Stress in their will. This is an important source of income for us and we plan to redevelop our legacy giving pack to provide better information to those who wish to remember Combat Stress in their wills and circulate this to prospective and existing donors. During the summer of 2015 we attended a number of the UK’s
Annual Report and Financial Statements 2015 Combat Stress
From October our Community and Outreach teams will be structured as a ‘hub and spoke’ model operating from The Royal British Legion high street Pop-in centres
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We are still treating Veterans from WWII and the Korean War.
county and agricultural shows to promote the weekly Forces Lottery to attract further subscriptions for tickets. We will also sell tickets locally in towns and cities in focused regional campaigns. We will be seeking to identify further contract opportunities to gain funding for our other treatment programmes – all of which are currently funded by voluntary donations. We receive very little statutory funding for our treatment of Veterans from Wales and Northern Ireland. In contrast, Veterans in Scotland and England receive funding from the NHS in England for the six-week PTSD Intensive Treatment Programme. In Scotland the NHS funds a substantial portion of the cost of all treatments of Scottish Veterans. We will be looking to secure further statutory funding for all treatments provided to Veterans in Wales and Northern Ireland, so there is equal access for all in the UK. There may be opportunities to secure contract funding for some of the therapies and activities delivered by our regional community teams or in our residential treatment centres. As a charity, we are always looking at ways in which we can do more with less. During 2015/16 we will explore further activities with our existing partners to share resources, increase our reach and improve efficiency. The cost of agency staff in the NHS has made the headlines over the last year and we have been similarly affected by the shortage of clinical staff and the consequential high cost of recruiting agency and locum
Annual Report and Financial Statements 2015 Combat Stress
staff. It is therefore increasingly important that we fill vacancies quickly with the highest quality employees, thus reducing the need for temporary staff. As well as keeping our costs manageable, this will also ensure that all Veterans receive consistent treatment and build rapport with their clinicians.
Developing an appropriate brand and image to deliver excellence As UK troops have now been withdrawn from the conflict in Afghanistan, there is likely to be less media interest in ex-Servicemen and women and therefore fewer prominent headlines, which help us gather support and increase understanding of the mental health issues experienced by our Veterans. However, we will continue to seek all opportunities to communicate the work we do and to demonstrate the effectiveness of our therapies and treatment. We will be starting to plan for our centenary year in 2019 and we will continue to work on our culture change which places Veterans at the heart of all that we do. We will be reviewing the impact and results of our re-brand since it was launched in 2013/14. In particular, we will look at whether younger Veterans are identifying better with the new brand and whether this may be one of the reasons they are seeking help from us earlier. Building on the success of the Military Mind Symposium, we hope to host a similar event in 2015/16.
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Combat Stress Tyrwhitt House, Oaklawn Road, Leatherhead, Surrey KT22 0BX General enquiries: 01372 587 000 Email: contactus@combatstress.org.uk Helpline: 0800 138 1619 Website: combatstress.org.uk Facebook: facebook.com/CombatStress Twitter: @CombatStress You Tube: Search for Combat Stress Charity LinkedIn: Search for Combat Stress Ex-Services Mental Welfare Society Company registered in England and Wales No 256353, Charity No 206002, Charity Scotland No SC038828