Teenage Cancer Trust Annual Report 2016/17 by Teenage Cancer Trust

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UP FOR A CHALLENGE: TEENAGE CANCER TRUST IN 2016/17 Chairmanâ&#x20AC;&#x2122;s letter 6 Acting CEOâ&#x20AC;&#x2122;s letter 8 Our year in numbers 10 We make every penny count: our finances 11 Where the story begins: our work before diagnosis 12 When the story changes: our work during treatment 16 The story continues: our work after treatment 26 Pushing for change, pushing ourselves: a look behind the scenes 30 Getting our house in order 31 Some of the legends who help make our work possible 32 A few very important thank yous 34 Fundraising aims and achievements 36 Financial review and results for the year 37 Financial management policies 40 Governance and management 41 Risk and safeguarding 42 Auditors report 45 Financial statements 48

David Hoare, Chairman

Every year at Teenage Cancer Trust is a collection of stories. Stories of determination. Stories of progress. Stories of hope. And, sometimes, stories of sadness. In this Annual Report, we want to guide you through a year in this amazing organisation by sharing these stories with you. It was a year in which we achieved a great deal together, against an increasingly tough backdrop. This was only possible thanks to our incredible supporters and staff, and we’d like to take this opportunity to thank everyone who helped us in any way in 2016/17. Because of you, we funded more staff than ever before so more young people with cancer could get expert support. We helped more young people understand the truth about cancer. We brought more young people together to share advice and be themselves. We did whatever we could to make sure young people didn’t face cancer alone. All of these are reasons for celebration, but it would be remiss not to mention that we also faced considerable challenges last year – and continue to do so, as we work to reach every single young person with cancer who needs us. Firstly, it is costing us more to maintain our existing services. Continued pressure on NHS finances mean that we are having to make a greater contribution to ensure that young people get the care they need. These financial pressures are also making it harder to recruit to new posts that were planned for the year, which means in some cases recruitment was delayed until the following year. Secondly, on the income side, we are operating in a difficult fundraising climate, and it is costing us more to fundraise for our work. The impact of this is that the percentage of income that we spent supporting young people with cancer fell slightly, although some of the reduction in expenditure on charitable work is linked to investment in projects that will ultimately increase our ability to fundraise effectively. It is, undoubtedly, a difficult combination. But the last thing we do in tough times is sit back and wait, and our determination to make sure every young person with cancer has access to our world-leading services has never been stronger. Our CEO Siobhan Dunn is currently on a period of extended leave, but we’ve had great support from our senior leadership team and trustees to make sure we stay on track to meet our targets. I’m delighted that Kate Collins, our Director of Fundraising and Marketing, has stepped up to Acting CEO role in Siobhan’s absence. Your support is more valuable now than it has ever been, so I’d like to take this opportunity to pass on my heartfelt thanks. Together, we will keep changing lives in these challenging times,

David Hoare Chairman

It’s always a joy to be part of the Teenage Cancer Trust team and I am proud to be supporting our remarkable organisation as Acting CEO. David has explained some of the challenges we faced last year and continue to face, but as we turn our attention to 2017/18, we’re clear how we need to respond. We’re focused on protecting and maintaining our existing services and continuing to work with the NHS in new and innovative ways, including our successful Nursing & Support programme which takes specialist teenage and young adult cancer care out into local hospitals and young people’s homes. We’re talking to our supporters to make sure we’re delivering what they need from us. We’re looking carefully at our brand, to check people understand who we are and how we can help. And we’re investing in the digital and technical skills we need to deliver better care, communicate more effectively and raise more money. Together, these priorities will enable us to work better than ever before and to become more resilient in a time of increasing uncertainty. I’m also delighted to let you know that we’re the official 2018 Virgin Money London Marathon Charity partner. It’s an incredible opportunity to raise £1.5 million to help us support more young people with cancer, and to introduce a whole new audience to our work. So there are plenty of reasons to be excited about the future – and about the difference we will continue to make. As the only UK charity that focuses our work solely on teenagers and young adults with cancer, we must keep improving to ensure we move closer to our goal of helping every young person who needs our support. That’s the story we’re continuing to write every day. And, with your help, that’s the story we will turn into reality. Thank you for being part of Teenage Cancer Trust,

Kate Collins Acting CEO

Kate Collins, Acting CEO

OUR YEAR IN NUMBERS Right now, for every young person we can support, there’s another we can’t. We want to offer every young person with cancer the support they need, when they need it – before, during and after diagnosis. This year, because of you, we’ve achieved a lot worth shouting about...

invested in life-changing cancer services Teenage Cancer Trust

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of young people** said their Youth Support Coordinator kept them motivated throughout treatment

WE MAKE EVERY PENNY COUNT... £13.9m: What we aimed to raise in 2016/17

copies of our Young Person's Guide to Cancer distributed

young people*

agreed our Find Your Sense of Tumour weekend was a great experience they would never forget

What we actually raised! In tough economic times, it’s a real achievement to have exceeded our fundraising target. THANK YOU!

In 2016/17, we spent 77p of every £1 donated on making sure young people didn’t face cancer alone.

young people took part in our Ultimate Backstage Experience at the Royal Albert Hall

* From surveys of 150 young people after our 2016 Find Your Sense of Tumour events ** From surveys of 99 young people at our 2016 Find Your Sense of Tumour events

To reach every young person with cancer, we need to raise at least £20 MILLION each year. In the current climate, we know this is a serious challenge – but we’re serious about making it happen. Until we do, young people will keep missing out on specialist care – often getting treated either with much younger children or in adult wards. Our focus on working efficiently and growing our income more sustainably has never been stronger. You can read our full fundraising review on page 36, or find out more on our website www.teenagecancertrust.org/money. 11

WHERE THE STORY BEGINS...

Let’s start where our work starts, and that’s not when a doctor first mentions the word cancer. Throughout last year, our Education Executives travelled the UK and Channel Islands, giving presentations to help young people sort the cancer facts from the cancer fictions. One in two people will now develop cancer in their lifetime, so it’s never been more important for all of us to be able to recognise potential warning signs. Knowing what to look for can lead to faster diagnosis and faster treatment within our specialist services, so our presentations pass on knowledge that could save lives – and help young people feel more confident talking about cancer. Of course, that’s often easier said than done. But our experts understand how to help young people feel comfortable and safe, sharing the truth sensitively and in a way that resonates. Through these presentations, we want to change the way a whole generation thinks about and understands cancer.

I just wanted to repeat a thank you for coming in as after your talk a student went to the doctors as was suffering from symptoms and has been diagnosed with lung and testicular cancer. This could have been ignored without your talk. - Louise, teacher

of students* surveyed said our education presentation increased their knowledge and understanding of the warning signs of cancer.

* From 3,953 surveys completed by students in 2016/17

• How c a n c e r s t a r t s • T h e d ifferent types of cancer le • Common c an c er s in y o u n g p e o p

• Ea r ly w a r ning si g ns • C ancer trea t me n t s g • Having ca nc e r w hen you ’ re y o u n ancer • Sup p o rt i ng so meo n e w ith c r • W a ys to re d uce the risk of c an c e

A boy who had lost his mum to cancer about a year previously was unsure about whether to attend my presentation. The teachers were quite nervous and thought he might leave the room. He sat through the whole thing and then came up to me afterwards. He didn’t say much but he did shake my hand and simply said ‘thank you so much for that. I can’t express to you how much this has helped me. Thank you for coming in’. It was a simple thing but I knew this was a big deal for him. - account from one of our Education Executives this year

WHAT WE SAID WE’D DO We wanted to talk to 225,000 teenagers and young adults about cancer, in 1,500 schools and colleges.

WHAT WE DID We spoke to 237,464 teenagers and young adults about cancer, in 1,434 schools and colleges.

WHAT WE’LL DO NEXT YEAR Speak to 225,000 teenagers and young adults in 1,500 schools and colleges.

THE LOWDOWN Our experts beat our target for the number of young people we wanted to reach, despite not making it to quite as many schools as we’d planned.

Last year, 7,784 people visited our online learning hub, downloading 1,050 resources.

It’s home to all kinds of lovely… • • • • •

GIVING GPS THE POWER OF KNOWLEDGE We teamed up with CLIC Sargent and the Royal College of GPs in 2017, creating a new learning module to help healthcare professionals recognise the signs of cancer in children and young people. Our research found that more than half of young people visit their GP at least three times before diagnosis, and this new module is part of our work to help every young person with cancer get the right support, when they need it. 530 people used the module in the first seven months after its launch in February 2017.

Lesson plans Factsheets Action packs Research Posters

WHEN THE STORY CHANGES

Young people don’t stop being young people after a cancer diagnosis. We’re here to make sure that’s always taken into account, and to help everyone – young people, their families and their friends – feel more ready for whatever they have to face. Last year, our specialist staff supported hundreds of young people in our 28 units in NHS hospitals across the UK and Channel Islands, as well as helping many more in other hospitals and in their homes. Young people with cancer have very different needs to children with cancer and adults with cancer. Imagine being a teenager in a ward full of six-year-olds or sixty-year-olds and you begin to understand why tailored care is so important.

half

But only of young people with cancer currently receive our specialist support. So we’re expanding our Nursing & Support Service to reach more young people in local hospitals and in their homes. The reach of this service is growing every year, as we work towards our aim to be there for everyone who needs us.

of young people* said that their specialist nurse was important to them throughout their treatment.

(87% last year**)

WHAT’S OUR NURSING & SUPPORT SERVICE? It’s a model of care that fills current service gaps and builds on the expertise we’ve gained from more than two decades spent working with – and listening to – young people with cancer and their families. It means we provide more nurses and specialist services in smaller hospitals and homes across the UK, so we can reach the young people who need us, wherever they live. And it means we work in partnership with the NHS to ensure our model is sustainable and meets the needs of young people. * From surveys of 113 young people at our 2016 Find Your Sense of Tumour events ** Sausman, C. (2016) Impact and Outcomes Methodology report for Teenage Cancer Trust, London. This data represents data amalgamated from surveys from 2013, 2014 and 2015

WHAT WE SAID WE’D DO • Complete the roll-out of our Nursing & Support Service in four regions • Fund 50 Teenage Cancer Trust nurses, 33 Youth Support Coordinators and 6 Multi Disciplinary Coordinators • Give out 1,250 copies of our Young Person’s Guide to Cancer • Give 50 grants to our specialist cancer staff for professional development, education and training

WHAT WE DID • Started rolling out our Nursing & Support Service in 5 regions – Northern Ireland, Scotland, the South Coast, the South West and the West Midlands • Funded 42 nurses, 30 Youth Support Coordinators and 6 Multi Disciplinary Coordinators. This included 6 new outreach nurses as part of our Nursing & Support Service, with 5 more due to be recruited early in 2017/18 • Upgraded our units in 6 hospitals in Birmingham, Cardiff, Leeds, Newcastle and Nottingham • Improved the facilities for young people with cancer in 9 local hospitals across the UK • Gave out 2,260 copies of our Young Person’s Guide • Provided over 100 grants to specialist staff. This included our Stephen Sutton grants, which enabled healthcare professionals to come to our Global Congress in Edinburgh, and our Stephen Sutton scholarships, which help healthcare professionals pay for postgraduate study and introductory courses on cancer in young people with Coventry University • Funded JTV Cancer Support, a project that gives young people with cancer the chance to make videos and use other media to make sense of what they are going through

WHAT WE’LL DO NEXT YEAR • Fund 58 nurses, 35 Youth Support Coordinators and 7 Multi-Disciplinary Team Coordinators • Complete the roll-out of our Nursing & Support Service in the 5 regions where we began to introduce it in 2016/17

THE LOWDOWN In a challenging NHS environment, we didn’t meet our target to recruit staff in the planned timeframe. That’s because, as the NHS limits its contribution to cancer services for young people, we need to increase our contribution. But our Regional Services team put in an extraordinary effort to get to this point, and in 2017/18 we’ll complete the roll-out of our Nursing & Support Service in the five regions where it was launched in 2016/17. We gave out almost twice as many Young Person’s Guides as we planned, boosting awareness of everything from different cancer treatments to coping if relationships get tough. We also funded more than twice as many professional grants as we planned.

HOW OUR GRANTS FOR SPECIALIST TRAINING IMPROVE CANCER CARE Continue to equip a pioneering and world-leading workforce supporting young people Ensure the support we offer young people keeps getting better Help staff learn the latest in cancer treatment Keep spreading awareness that young people need specialist care

CONNOR NOTTINGHAM

I was treated in the Teenage Cancer Trust unit at Nottingham Queen’s Medical Centre. The unit was so nice that it didn’t feel like a hospital. And I had Bex, our Youth Support Coordinator to support me. I knew that for most of my stay I had someone to talk to about anything, whether it was a concern or just a chat. She brightened the unit and kept the mood up, which brought everyone together. I got the all-clear in February 2017, and six weeks later I completed a challenge to climb Mount Snowdon. I raised over £5,000 for Teenage Cancer Trust and Ward E39 at Nottingham Queen’s Medical Centre. All the staff there are mine and many other people’s heroes, and I will never be able to show them how much I appreciate them saving my life.

Here’ s me and my friend’s little brother in December 2016, who also has cancer. It just happened that we were in hospital at the same time so they came to visit me.

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th e te en ro om an d pl ay po ol an d w at ch t v an d ch il l ou t li ke w e w ou ld if w e w er e at o n e of ou r ho us es .

LIZ WATT

TEENAGE CANCER TRUST NATIONAL LEAD NURSE FOR TEENAGERS & YOUNG PEOPLE WITH CANCER IN SCOTLAND

This year one of my highlights has been seeing the launch and evolution of our Nursing and Support Service in Scotland, a project that will radically change the way we offer teenage and young adult cancer care in Scotland. We’ve had dedicated young person's cancer services in West and South East Scotland for some time, but until recently, many of the young people with cancer living in other parts of Scotland didn’t receive support from a teenage and young adult cancer specialist. It’s hard to emphasise what a difference this service makes for young people and their families – the nurse acts as a keyworker, offering 1:1 support on a broad range of topics and helping to coordinate their care. They advocate for them, make sure they receive the right information at the right time, and that they understand what’s happening to them.

of young people* said their specialist nurse supported their family, friends and carers.

(78% last year**)

These young people were really missing out on vital specialist care for their age-group, but the roll-out of the programme will mean there’s a level playing field, wherever you live in Scotland. It’s wonderful to see the benefits for young people and their families, and also to see cancer specialists in the NHS start to see how valuable the service is. * From surveys of 113 young people at our 2016 Find Your Sense of Tumour events ** Sausman, C. (2016) Impact and Outcomes Methodology report for Teenage Cancer Trust, London. This data represents data amalgamated from surveys from 2013, 2014 and 2015

Teenage Cancer Trust Units Regions where weâ&#x20AC;&#x2122;d rolled out our nursing and support service (pre 2016-17) Regions where we started to roll out our nursing and support service in 2016-1

(Northern Ireland, Scotland, the South Coast, the South West and the West Midland

I work across Taunton and Exeter with young people who have been diagnosed with cancer and have chosen not to receive treatment at the principle treatment centre in Bristol.

ROSIE

SUPPORTED BY OUTREACH NURSE LORRAINE, EXETER Lorraine explained what was happening to me in a way that was easy to understand, avoiding jargon completely. She knew exactly what I needed to hear, and gave me her phone number and email address to contact her at any time. Lorraine has been my rock this whole time. We’re still in touch, and I still go to the peer support events. It’s so nice to see them and to ask any queries that I have. She texts me to see how I am and when my next appointment is, to see if I need her to come with me.

This means that they’re not based on a Teenage Cancer Trust unit, and it is highly unlikely that they will meet another young person with cancer during their time in hospital. Supporting a young mum brings an extra dimension to the support we offer. Rosie had a young child, was about to get married, living in a new house. So being told she had got cancer and adjusting to a ‘new normal’ after treatment exacerbated some of her pre-existing conditions and affected her mental well-being and connection to her toddler. We offered a lot of regular text, telephone, face to face 1:1s and peer support. Being a keyworker means there’s one consistent point of contact liaising between her medical team and advocating on her behalf. We have accessed other charities and support in order to supply extra nursery funding for her daughter, particularly whilst she coped with treatments and side effects, and through counselling and therapies locally. We also have access to family therapy for children of a parent with cancer.

The first night out made me feel normal, for the first time in a very long time. To meet other people who are also going through probably the hardest thing they ever will makes you feel like you are not alone. The night outs are great because the cancer barely comes into it. It’s a few hours where teenagers/young adults don’t have to think about everyday life and can just have a laugh and meet new friends going through the same thing and share experiences, offer advice and be normal.

LORRAINE

TEENAGE AND YOUNG ADULT CLINICAL LIAISON NURSE IN EXETER 22

James, Jack, Lewis, Hollie, Lily, Leyla, Omar, Toby, Beth, Matthew and Dannii, all treated on our unit at Addenbrookes Hospital, Cambridge in 2016/17 23

OLIVIA GLASGOW

My Youth Support Coordinator Lisa is fantastic. She’s totally bright and bubbly. It was great to have someone other than my Mum to talk to. She was a shining light in a dark time. When I was in isolation for five weeks, Lisa came in every day to cheer me up. It was December 2016 and I remember Mum joking about buying me flat pack furniture for Christmas, as I absolutely love building things. Lisa suddenly said, ‘I’ve got a plan!” She came back with this amazing wooden 3D puzzle. You have about 300 little pieces and minimal instructions and from those you build a tank. It was the most stressful thing ever, but I did it!

Olivia's tank!

of young people* said that their YSC was important to them throughout their treatment.

(89% last

year**)

MATES MATTER It’s stressful enough getting a cancer diagnosis when you’re young – and then you need to let people at school know what’s going on. It’s often a real struggle. Many young people end up feeling misunderstood or even getting bullied.

We emphasise everything the young person wants to get across, and hopefully make their life a little easier.

Our Mates Matter programme helps young people with cancer to say whatever they want to say – through us. Our experts find out what’s on their mind, and then give a tailored version of our Understanding Cancer Together presentation at their school.

“Hi Ellen, thank you for everything today. It was so good. My friends all said it was informative and helped them get an insight in how cancer and chemo works. Thanks again.” - Email from student, 2017

Between the launch of Mates Matter in November 2016 and July 2017, 40 young people were referred to the service.

* From surveys of 99 young people at our 2016 Find Your Sense of Tumour events ** Sausman, C. (2016) Impact and Outcomes Methodology report for Teenage Cancer Trust, London. This data represents data amalgamated from surveys from 2013, 2014 and 2015

THE STORY CONTINUES

As teenagers and young adults adjust to whatever the future holds, we’re there to offer advice and bring young people together. The end of treatment can bring a whole new load of challenges, and we're here to help ease that transition. Our expert staff offer guidance on everything from long-term side effects to returning to school or work.

WHAT WE SAID WE’D DO Bring together 260 young people at our Find Your Sense of Tumour weekend and 105 at our Way Forward programme

WHAT WE DID 261 young people came to Find Your Sense of Tumour and 80 came to Way Forward 112 young people took part in our Ultimate Backstage Experience at the Royal Albert Hall

And our Find Your Sense of Tumour Conference and Way Forward events give young people the chance to be there for each other. Sharing ideas, advice and worries at these events can make a world of difference, because no one gets what you’re going through quite like someone who’s going through it too.

WHAT WE’LL DO NEXT YEAR Support 260 more young people at Find Your Sense of Tumour and 105 at our Way Forward programme

THE LOWDOWN We brought hundreds of young people together at our support events. And while we had to cancel one of our Way Forward programmes, we hit our target for our Find Your Sense of Tumour conference.

I went to Teenage Cancer Trust’s Find Your Sense of Tumour conference and the Way Forward programme last year – they’re absolutely priceless. They give you the opportunity to meet people who know what you’re going through and have group discussions about difficult issues.

JACK LONDON

I remember a session on fertility – one guy had recently got married and he and his wife were trying for a child. He talked about the difficulties of going through IVF. That’s not the sort of conversation that’s easy to bring about, but these events are fantastic for helping people to open up and share. 27

I was discharged in April 2017, just before my 19th birthday. In June I went on the Teenage Cancer Trust’s Way Forward programme. I felt proud of myself, as it was the first time I’d gone anywhere without my Mum nearby. It was good to see old friends and the talks were really informative. There was one from a physio that stood out for me. He said that for some people, exercise is about running a marathon, while for others it’s brushing their teeth - and the most important thing is to set yourself goals. I’ve got mobility issues, so that really made me feel better about myself. - Olivia, Glasgow

of young people* felt more resilient and better equipped to cope with their own challenges as a result of attending the Way Forward programme

(100% last year**)

Quite often, during and after treatment, it can be hard to relate to people your age. Your life experiences are vastly different. FYSOT brings you together with people who have similar concerns: fertility, fatigue, and life after treatment. I met so many amazing people during the event, and found it really informative. I felt more in control of my health; more informed about questions or issues I could raise with my medical team.

of young people agreed*** that Find Your Sense of Tumour was a great experience they would never forget

I think the main thing I appreciated was how ‘normal’ I felt; I wasn’t the ‘cancer’ person in the room. No one gave me pitying looks for having short hair, speaking about fatigue, or sharing chemo stories. - Ruth, Cambridge

(new stat this year) 28

* From surveys of 76 young people after Way Forward events in 2016/17 ** Sausman, C. (2016) Impact and Outcomes Methodology report for Teenage Cancer Trust, London *** From surveys of 150 young people after our 2016 Find Your Sense of Tumour events

THEYâ&#x20AC;&#x2122;RE NOT CALLED ULTIMATE EXPERIENCES FOR NOTHING... Each year, we arrange a series of Ultimate Backstage Experience workshops at the same time as our Royal Albert Hall shows. Young people who have been through cancer treatment get to write and perform an original song at the iconic London venue, with help from the stars playing that evening. In 2017, 112 young people took part in the workshops, with musicians including Ollie Murs and Busted joining in with the creative, therapeutic sessions.

The Royal Albert Hall Backstage Experience is one I will treasure for life. I have never been prouder to stand on that stage and have known I have been so supported by such an incredible charity. It gave me the opportunity to meet people I never usually would. Once in a lifetime! - Rosie, Exeter

of young people said that the Ultimate Backstage Experience had a positive impact on them.

(98% last year) 29

PUSHING FOR CHANGE, PUSHING OURSELVES

PUSHING FOR POLICY CHANGE On our own and in partnership, we work with policy makers and commissioners to improve care and raise awareness of why specialist support is vital. In 2016-17, we: Turned cancer strategies into lasting change Continuing to track the implementation of national cancer strategies across the UK, weâ&#x20AC;&#x2122;ve made sure that actions about young people are progressed and put into practice. Made big progress in Parliament Throughout last year, we laid the groundwork for the first All-Parliamentary Group on Children, Teenagers and Young Adults with Cancer, in partnership with CLIC Sargent. It launched in October 2017, and will play a vital part in raising awareness of the issues affecting children, teenagers and young adults with cancer and their families in Parliament, and create opportunities to influence policy. Told politicians about our education work We launched a report on our education work in Parliament and have attended meetings across the UK with Government representatives to ensure they know about our education work and how to work with us. Ensured young people were heard We helped young people share their experiences through blogs and social media and at meetings with MPs and policy-makers. Ten blogs from young people about the General Election in May 2017 reached nearly 350,000 people on social media. Put data on the agenda Developed a strong partnership with Public Health England working on accurate national data and analysis about young people with cancer Made waves in Scotland We supported Scottish First Minister Nicola Sturgeon to open our Global Congress. Achieved more through collaboration In total, we worked with 14 coalitions and pressure groups in 2016-17 and became one of the 50 most-mentioned charities in Parliament.

GETTING OUR HOUSE IN ORDER We want to offer expert support to every young person with cancer in the UK. To do that, we need to work as efficiently as we possibly can â&#x20AC;&#x201C; now more than ever due to the challenging financial environment. This year, we focused on improving our ways of working and on building the infrastructure we need to increase our income. We introduced new HR systems and finance processes, transformed our IT provision, reviewed our data management and launched new communication messages to help people understand what we do. Piece by piece, each of these steps will move us closer to a world where no young person faces cancer alone. 31

LEGENDS? WE KNOW PLENTY

he t f o w e af Here are le b i d e r c n i ho do w s d n e g le ter t e b e f i l ake m o t s g cer n i n a th c h t i w ple o e p g n u for yo 32

LOUD LEGENDS… This year we celebrated the 100th Teenage Cancer Trust gig at the Royal Albert Hall, with The Who performing an unforgettable set supported by another music legend, Noel Gallagher. The Who’s Roger Daltrey CBE – our Honorary Patron – was instrumental in setting up these gigs back in 2000, and we can’t thank him enough for helping to create this century of stratospheric shows.

LONGSTANDING LEGENDS… We owe so much to our Founders and Life Presidents Dr Adrian Whiteson OBE and Myrna Whiteson MBE, and to our Honorary Patron Sarah Duchess of York, who has supported Teenage Cancer Trust since our launch in 1990. And we couldn’t be more excited that the Duchess of York’s daughters, HRH Princess Eugenie and HRH Princess Beatrice, also became Honorary Patrons in 2016.

CORPORATE LEGENDS… Domino’s helped raised an incredible £806,143 for young people with cancer last year, through everything from special promotions to fancy dress days. The company also played a vital part in helping young people and families on our units get together, by providing the pizzas for our monthly pizza nights. And 2017 also saw the launch of a major partnership with Aldi. The company is aiming to raise £5 million over the next five years, and was on track to raise £1 million by the end of the first year, with 600 staff completing challenges from skydives to mud runs. Phenomenal.

FUNDING LEGENDS… The Queen’s Trust has given us life-changing funding since 2013, and last year donated £504,000. That money paid for all of our Find Your Sense of Tumour and Way Forward events, as well as our Young People’s Guide to Cancer. Or, to put it another way, the Queen’s Trust brought young people together and made sure they were supported and informed. That’s a huge impact, and we’re hugely grateful.

… AND HUNDREDS OF LEGENDARY THINKERS Thanks also to the 350 health professionals from around the globe who joined us at our Global Congress in December 2016 to talk treatments, research and the latest developments in teenage and young adult cancer care. Together, we’ll make sure exceptional care becomes the norm.

WEâ&#x20AC;&#x2122;VE GOT A LOT OF THANK YOUS TO SAY

To every single person who supported us in 2016/17, thank you so much. In challenging times, your incredible efforts help us make sure that no young person has to face cancer alone.

FUNDRAISING AIMS AND ACHIEVEMENTS We rely wholly on voluntary fundraising and never lose sight of one vital fact: we couldn’t do what we do without the generosity, commitment and passion of people across the UK and Channel Islands. As ever, this year we were humbled and in awe of the unbelievable lengths people went to for our work. Our aim this year was to achieve our income budget of £13.9m, and the passion and commitment of our incredible supporters meant that we raised £2.1m more than this.

OUR APPROACH TO FUNDRAISING In the current economic climate, it continues to be essential to develop a broad-based fundraising strategy so that a charity has a mix of income streams. Most of our fundraising is managed by our staff with the support of corporate partners who operate as ‘commercial participators,’ as defined in the Charities Act 2011. We do not employ any professional fundraising organisations. Our values and heritage are strongly in relationship-driven fundraising rather than high-volume mass fundraising and we continue to be committed to our relationship-focused approach as we grow our income. We do all we can to make sure we are not putting the need for income generation ahead of the needs of supporters and/or the needs of young people. We have continued the work of the sub-committee of our Board of Trustees – the Fundraising and Marketing Committee – to help ensure that our fundraising and marketing practices (whether direct, through partners, suppliers or volunteers) reflect and reinforce our values. As part of this work we have captured our Fundraising Principles and published them externally as well as sharing them with all staff within the charity. We use them to guide all our decision-making about activity with supporters and potential supporters.

We are members of the Fundraising Regulator and Institute of Fundraising and ensure we comply with the Fundraising Codes of Practice. We have also developed a Complaints Policy for the organisation and have clear procedures within the charity for handling complaints. Our Complaints Policy and the procedures that accompany it have been designed to help us build a relationship with the complainant so that each complaint is treated as an opportunity for us to improve. Within the 16/17 year we received 17 complaints about fundraising and positively resolved them all within the charity without escalation to the Fundraising Regulator.

FINANCIAL REVIEW AND RESULTS FOR THE YEAR The Consolidated Statement of Financial Activities (SOFA) set out on page 48 shows the financial results for Teenage Cancer Trust and its trading subsidiary.

INCOME This year our income increased by 5% compared to 2015/16. In these difficult economic times, any growth should be celebrated as a real achievement.

This is 3p less than the three-year average reported in 2015/16, which highlights the challenges of raising income in the current climate. Like all charities, we are working so much harder to raise every pound.

But, despite this growth, our income has fallen short of what we need to reach every young person with cancer by extending our nursing and support services across the UK. To achieve this strategic goal, we now need to see a significant and sustained increase in income.

This figure is an average over a three-year period, which ensures that significant events in any single year do not have a distorting effect. This calculation excludes income and expenditure relating to our fundraising trading activities, such as events, challenge registration fees and cause-related marketing activity. For further details, please see our website.

Until this happens, the reality is stark: we will not have the funds to support every young person wherever they choose to be treated.

OUR FINANCIAL YEAR IS CHANGING

So our focus on raising more money at an improved rate of return is now sharper than ever. In 2017/18, we will invest in research to understand the needs and motivations of our core audience. This will help us to generate income and support in a more sustainable and cost-effective way. It will also give us a new level of insight, which we can use to help strengthen our digital capability. Income from our corporate supporters was down 20% in 2016/17, but this was offset by an increase in income from regional fundraising and the Royal Albert Hall shows. This increase reflects many achievements worth celebrating: the unbelievable commitment of our supporters; the awesome support of our friends in the music industry; and an extraordinary effort from all teams across the charity. More generally, it also reflects increasing awareness of our work and impact. Of every £1 donated to Teenage Cancer Trust, 77p is spent on supporting young people with cancer.

Our accounting year has always run from July to June, but we’re changing this so it runs from January-December. This will allow us to align our planning and budgeting so it’s slightly ahead of the NHS, meaning our ability to support posts can be fed into NHS plans. It will also remove budgeting and planning pressures at our busiest time of year – March, April and May. And it means we’ll generate more income in the first half of our financial year, making accurate budgeting slightly easier. To accommodate this change, our next financial period will run from 1 July 2017 to 31 December 2018. However, our operational plans, and the 2017-18 targets you see in this report, are for the year to 30 June 2018. Early in 2018 we will complete the planning and budgeting for the final 6 months of the current accounting period. We’ll then move to our new planning and budgeting cycle in autumn of 2018 for the financial year ending on 31 December 2019.

EXPENDITURE

RESERVES

Overall direct charitable expenditure fell by 2% compared to last year. The 2% fall in costs reflects the decrease in capital build projects and the end of a longstanding research commitment.

We had unrestricted reserves of £15m at the end of the year and restricted reserves of £451k.

Last year we stated that our aim was to complete the roll-out of the Nursing & Support Service in a further four regions during the year. This did not happen as, in a difficult NHS environment, it took much longer than we anticipated to achieve the necessary buy-in from the NHS Trusts who host these services. We are pleased to say that all of the budgeted posts have now been approved by the relevant NHS Trusts and staff will be appointed during 2017/18. Any further roll-out to the remaining regions across the UK beyond this will be entirely dependent on raising the necessary funds. Support costs and governance costs remained at 10% of our total expenditure. This reflects the positive impact of our ‘build’ projects, which have kept costs stable while extending our capacity and scale. Staff costs for employed staff increased by 2%, which reflects the 2% pay rise in July 2016. Head count increased by 5%, whereas the average salary across the organisation decreased by 3%. There were increased staff numbers in both fundraising and services.

STEPHEN SUTTON We invested £1.86m of money donated to us through fundraising inspired by Stephen Sutton to support young people with cancer in 2016/17. This enabled us to refurbish units in hospitals, provide scholarships, fund our education work and pay transport costs so young people could travel to our Find Your Sense of Tumour events. We are so grateful for everything that Stephen has made possible.

In total, our reserves increased by £456k compared to the previous year as a result of the surplus generated in the year. Unrestricted reserves increased by £677k, whereas restricted reserves fell by £221k. Unrestricted reserves at the end of the year are in line with our reserves policy (see page 40). Restricted reserves continue to be well managed. Restricted donations are spent at the earliest opportunity. Of the £451k available at the end of the year, it is estimated that approximately 47% will be spent in 2017/18.

TRADING SUBSIDIARY We have one wholly-owned trading subsidiary, The Teenage Trust (Trading) Limited, which is incorporated in the United Kingdom. This subsidiary organises and holds fundraising events for Teenage Cancer Trust and passes its taxable surplus to Teenage Cancer Trust under Gift Aid. In 2016/17, the concerts at the Royal Albert Hall were our biggest fundraiser. The taxable surplus for the year to be Gift Aided to the charity amounted to £1,137,018, compared to £409,581 in 2016. This increase reflects the huge success of the week of shows. Seven performances were held in all, compared to six in 2016, and a stellar line up enabled us to maximise the return from this unique opportunity.

PRINCIPAL RISKS AND UNCERTAINTIES The Trustees have developed a risk framework that clearly differentiates between the risks we face. These are: • Strategic risks, which impact our ability to deliver our strategy • Operational risks, associated with internal operations, processes and ways of working • Project risks, associated with the delivery of individual projects • Event risks, linked to specific events. Strategic risks are the main focus of the Trustees. These must be understood and managed for us to achieve long-term success. As at 30 June 2017, the principal strategic risks, and their management strategies, were identified as:

Risk

Management Strategy

Failing to raise the income required to meet all ongoing revenue obligations

Brand review, digital audit, impact reporting, financial planning, scenario planning, reserves management, building a diverse and robust fundraising portfolio, monitoring performance and return, compliance with GDPR

Being unable to support every young person with cancer across the UK

Impact reporting, lobbying, building key relationships and influencing future NHS policy, exploring digital opportunities

Sustaining reputational damage, particularly in connection with the charity’s safeguarding obligations when working with children and vulnerable adults

Safeguarding best practice – policy, procedures, training for all staff and Trustees

For full details of our risk policy and risk management practices, see page 42. This is the end of the charity’s Strategic Report as required by the Companies Act.

OUR WORK IN SCOTLAND Teenage Cancer Trust is registered with the Office of the Scottish Charity Regulator (OSCR) (registration number SC039757). Our work in Scotland comprises specialist teenage and young adult cancer services in hospitals and cancer education. In 2016/17, we provided specialist cancer facilities and specialist staff at the Royal Hospital for Children and The Beatson, West of Scotland Cancer Centre in

Glasgow, and at the Royal Hospital for Sick Children and Western General in Edinburgh. We also funded our Education and Awareness Programme in Scotland, aiming to educate all 13-24 year olds about the signs of cancer. This is particularly important for early detection of melanoma, which is on the rise among young people in Scotland. We currently have 12 members of staff in Scotland.

FINANCIAL MANAGEMENT POLICIES RESERVES POLICY Restricted funds Restricted funds are held until we can spend them according to our supporters’ wishes. In the rare event we can’t do that, our Trustees contact the supporter to ask if their donation can be transferred to our unrestricted funds. It is our policy to spend restricted funds as quickly as we can. Unrestricted funds During the previous year, the Reserves Policy was reviewed as an integral part of the financial governance of the new strategy to reach every young person with cancer in the UK. This review included an extensive benchmarking exercise across the sector. In view of the significant ongoing revenue commitments that the charity faces both in terms of employed staff and funded staff, the Trustees agreed that base reserves should be increased to protect services in the event of a fall in income below budget in the short- or medium-term. This is the only material reason why the charity maintains a reserves base. The revised policy states that unrestricted reserves should not fall below the equivalent of six months’ running costs or rise above twelve months’ planned running costs. At the end of the financial year, this meant that reserves should be between £8m and £16m. The amount of unrestricted reserves, excluding designated funds and fixed assets, at the balance sheet date was £14.6m. As this falls within the approved range, and financial planning for the coming years provides for a steady growth in income to support the planned expansion in services, the Trustees are comfortable that no immediate action is required to either increase or reduce the level of unrestricted reserves. However, this position will be reviewed on a regular basis and our ambitions for our services will be adjusted to reflect revised income budgets and forecasts. The only designated fund is the fund that the Trustees set up in 2014 for fundraising inspired by Stephen Sutton. Income to this fund amounted to a 40

further £68k during the year and, after expenditure and transfers during the year of £1.86m, the balance at 30 June 2017 was £314k. This fund will continue to be spent in accordance with the public announcement in May 2016. Investment policy In the year under review, due to the continued uncertainty in the markets and the banking sector, the investment policy remained unchanged, stipulating that funds could only be held by banks with a strong security rating. To this end, all cash deposits were held at Royal Bank of Scotland and Barclays Bank, our chosen retail banks. At the year end, £6m of cash reserves was invested in fixed term deposits at Barclays and Royal Bank of Scotland to attract a slightly improved rate of return. The investment policy is under constant review.

EMPLOYEES Teenage Cancer Trust operates an equal opportunities recruitment policy. The Remuneration Committee is responsible for overseeing the charity’s pay and reward structures and approving annual pay increases. The long-term success and performance of Teenage Cancer Trust is directly linked to the talents, motivation and accomplishments of our employees, and we recognise the importance of developing our employees and building our capability as an organisation. We do this by recruiting great people, by building high levels of relevant skills and knowledge through our learning and development programme, and by providing a stimulating and rewarding work environment.

PENSIONS The pension benefits offered by Teenage Cancer Trust consist of a defined contribution scheme into which Teenage Cancer Trust will contribute up to 5% of gross salary (dependent on employee contribution) to assist staff in reaching their target pension.

GOVERNANCE AND MANAGEMENT GOVERNING DOCUMENT Teenage Cancer Trust is a company limited by guarantee governed by its Memorandum and Articles of Association last modified 28 July 2014. It is registered as a charity with the Charity Commission. The Board The Board of Trustees is responsible for the strategic governance of the charity. In the year ended 30 June 2017 the number of Trustees serving on the Board was nine (2016 – nine). The Board of Trustees meets six times per year and is responsible for setting the overall strategy of the charity. At each meeting the Board receives written reports on all aspects of the charity’s work. The Trustees have carried out a skills audit to identify specific skill sets that would strengthen the Board’s overall effectiveness. The Board operates an equal opportunities recruitment policy and Trustees that are recruited are required to have demonstrable experience in the areas identified by the skills audit. New Trustees follow a similar induction process to that of all new staff; they are required to spend some time in the office, visit a unit, attend an Education and Awareness presentation, and meet key members of staff. All of the Board also undergo safeguarding training and generally gain an understanding of all aspects of the work of Teenage Cancer Trust. Ongoing training for Trustees is provided as required in support of the role. In addition, all Trustees are required to gain a full understanding of their legal obligations in taking on the role of Trustee. Statement of Trustees' responsibilities The Trustees are responsible for preparing the Strategic Report, 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 in accordance with United Kingdom Generally Accepted Accounting Practice (United Kingdom Accounting Standards and applicable law). 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 group and charity and of the incoming resources and application of resources, including the income and expenditure, of the group for the year. In preparing those financial statements the Trustees are required to: • Select suitable accounting policies and then apply them consistently • Make judgments and accounting estimates that are reasonable and prudent • State whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the financial statements • Prepare the financial statements on the going concern basis unless it is inappropriate to presume that the charity will continue in business The Trustees are responsible for keeping adequate and proper accounting records that are sufficient to show and explain the charity's transactions and disclose with reasonable accuracy at any time the financial position of the group and parent charity, and enable them to ensure that the financial statements comply with the Charities and Trustee Investment (Scotland) Act 2005, regulations 6 and 8 of the Charities Accounts (Scotland) Regulations 2006 (as amended) and with the requirements of the Companies Act 2006. They are also responsible for safeguarding the assets of the group and parent charity and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

Financial statements are published on the charity's website in accordance with legislation in the United Kingdom governing the preparation and dissemination of financial statements, which may vary from legislation in other jurisdictions. The maintenance and integrity of the charity's website is the responsibility of the Trustees. The Trustees' responsibility also extends to the ongoing integrity of the financial statements contained therein. Trustees’ awareness statement Each of the Trustees has confirmed that so far as they are aware, there is no relevant audit information of which the charity’s auditors are unaware, and that they have taken all the steps that they ought to have taken, as a trustee, in order to make themselves aware of any relevant audit information and to establish that the charity’s auditors are aware of that information. Management The Board delegates certain areas of governance to committees comprising those Trustees with relevant commercial experience.

The sub-committees comprise: • The Audit Committee, which meets with the charity’s auditors both at the planning and completion stages of the audit. It is responsible for monitoring the implementation of the auditors’ recommendations and recommending the annual report and accounts to the Board • The Risk and Safeguarding Committee, which meets four times a year and is responsible for reviewing the strategic risks and ensuring robust risk management practices throughout the charity • The Remuneration Committee, which is responsible for overseeing the charity’s pay and reward structures and approving annual pay increases; and • The Fundraising & Marketing Committee, which is responsible for ensuring that all Trustees have confidence in the methods and ethics of fundraising conducted on their behalf for Teenage Cancer Trust, whether by employees, volunteers or by contractors/suppliers and that all activity for Teenage Cancer Trust upholds the values of the organisation

RISK AND SAFEGUARDING The Risk and Safeguarding committee comprises two Trustees, who meet four times a year with senior members of staff who represent relevant aspects of the charity’s work, including the Director of Finance and Strategic Performance (who is the executive lead on risk management), and the charity’s safeguarding lead. Risk The Trustees have a formal risk management process in place to assess the major risks to which the charity is exposed. This process identifies the types of risks the charity faces, prioritises them in terms of likelihood of occurrence and potential impact and identifies means of mitigating these risks. Risk management practices, including incident reporting, are embedded throughout all of the charity’s operations. They form an integral part of all business decisions and underpin management’s strategic thinking. Risk management is also the main driver for the development of the charity’s policy and procedures framework covering all areas of 42

operations. Further, all projects and events are required to have a detailed risk assessment prepared at the planning stage, which will play a key role in determining whether or not the project or event should proceed. The risk assessment process identifies risks faced by the charity and ensures that, where appropriate, adequate measures are in place to minimise each risk. Overall responsibility for ensuring this process is carried out effectively lies with the Risk Committee and the Director of Finance and Strategic Performance. Details of the most significant risks facing the charity and its subsidiary are detailed on page 39 together with the principal mitigating factors.

Each quarter, progress against the strategy is formally measured and reviewed and the most significant risks to meeting the strategic goals are identified and reported to the Trustees. Safeguarding The Trustees have overall responsibility for ensuring that the charity has proper safeguarding procedures and policies in place to ensure the safety and protection of the children and vulnerable adults with whom it works. They have due regard to the guidance issued by the Charity Commission and have all read the Department of Education’s guidance document ‘Safeguarding for Trustees’. Policies and procedures which have been implemented include: • The appointment of a Trustee with overall responsibility for safeguarding and a safeguarding lead • Safe recruitment policies including full DBS (Disclosure and Barring Service) checks for all staff working with young people • Safeguarding training for all Trustees and staff commensurate with their roles and responsibilities – to be repeated for each individual every 2 years • Clear procedures and guidance for all Trustees and staff so that they are clear about how to report any concerns

Chief Executive The Board delegates the running of the charity to the Chief Executive, who is responsible for the delivery of the agreed strategy and for ensuring that the charity’s policies are adhered to at all times. The Chief Executive is assisted in this task by the Senior Leadership Team who report to her and meet at least twice a month. Since May 2017, the Chief Executive has taken an extended period of leave. During the summer period the Senior Leadership Team jointly took on the day-to-day running of the charity, supported by the Chair and Trustees, and since October 2017 Kate Collins, Director of Fundraising and Marketing, has stepped up to Acting CEO in Siobhan’s absence. These interim arrangements have worked well and the Trustees fully anticipate that Siobhan will return to her post early in 2018. Related parties None of the Trustees of the charity receives any remuneration or other benefit from their work with the charity. Expenses incurred in the course of performing Trustee duties are reimbursed by the charity and are disclosed in note 19 to the financial statements. Auditors BDO LLP was re-appointed as auditors in the year in accordance with the Companies Act 2006.

• Robust risk and safeguarding assessment practices so that individual events are always managed in such a way to protect young people, staff and volunteers

The Report of the Trustees (including the Strategic Report) was approved by the Board of Trustees on 11 December 2017 and authorised to be signed on its behalf by:

David Hoare Chair of the Board