Spinal Foundation Trustees
CHAIRMAN'S REPORT
The Trustees submit their annual report and the financial statements of Spinal Foundation Rochdale (the Charity) for the year ended 31 March 2007. The Trustees confirm that the annual report and financial statements of the Charity comply with current statutory requirements, the requirements of the Charity's governing document and the provisions of the Statement of Recommended Practice (SORP) "Accounting and Reporting by Charities: revised 2005" published in March 2005.
STRUCTURE, GOVERNANCE AND MANAGEMENT
Method of appointment or election of Trustees
The Management of the Charity is the responsibility of the Trustees who are elected and co-opted under the terms of the Trust Deed.
Related party relationships
The Trustees who served the Charity during the period were as follows:
V J Peel
W Kintish
A.D. Dempsey
S.J. Keyworth (from 13 March, 2006)
After the end of the period, V.J. Peel and W. Kintish both resigned with effect from 31 May, 2006 and S. Fielding was appointed as a Trustee from 18 September, 2006.
OBJECTIVES AND ACHIEVEMENTS
Constitution policies and objectives
The major restriction on the day-to-day activities of the Foundation has continued to be the 1999 change in government policy to severely restrict the use of non-NHS service providers, even charities such as us, to provide services to NHS patients. This means that a large number of patients who their GPs wish to be treated at the Foundation have their referrals delayed for many months whilst specific approval is sought from Health Authorities or Primary Care Trusts. In some cases, having got approval, some patients have even had treatment artificially deferred so as not to have faster treatment than other NHS patients. Further serious financial difficulties have been caused by NICE publishing on its website the results of their review of this approach to treatment of chronic back pain. On the basis of legal advice, we have vigorously contested the evidence given to NICE, its review process and its conclusions. They asserted that the clinical approach taken is effectively "not proven", and would like to see a Randomised Control Trial, ironically as one had been approved by the DOH but, principally as a result of their comments, was then not able to be prosecuted. As reported last year, we wished to complain to the Health Service Ombudsman but were advised that NICE did not fall within its purview. However, as a result of vigorous lobbying, NICE became subject to the Ombudsman¡¦s jurisdiction in March, 2005. Accordingly, a formal complaint has been made on behalf of the Foundation which is currently being progressed.
We have also been given hope by the publication of further scientific clinical papers that appear to vindicate the clinical results of the work enabled by the Charity. Furthermore there has been accelerating international adoption of the procedures developed through the Charity with over 100 surgeons now adopting Mr. Knight's approach.
The foundation is governed by a Trust Deed dated 22 April 1994 and is registered under the Charities Act 1993. The objectives of the foundation are to research and promote the provision of spinal surgery by endoscopic techniques and other ancillary care and facilities to relieve chronic back pain, and to benefit medical science generally.
ACHIEVEMENTS AND PERFORMANCE
Review of activities and future developments
The aims of the Foundation have been met by entering into an arrangement with NHS Primary Care Trusts and other similar referring agencies who provide funds for appropriate spinal investigations and treatments, including surgery, for patients with chronic back pain. That surgery is subcontracted to Mr. Martin Knight, the Settlor of this Charity. These arrangements have been entered into because Mr. Knight remains the most appropriate contractor in the UK. This is because of the research carried out by him in the area and due to his own skills that have been advanced by the significant number of procedures carried out by him.
Internationally there has been a further acceleration of the international adoption of the procedures developed through the Charity with over 300 surgeons now adopting endoscopic approaches to the treatment of chronic back pain as researched and developed through the efforts of the Charity.
During 2004 the Government's policy has changed to include Choice and Book and they have allowed more non-NHS service providers to provide services to NHS patients. We were at first optimistic that this would allow the Charity to revert to the healthy financial position it sustained for its first six years. However, the Spinal Foundation, as a non-NHS Provider, cannot be included in the Choice and Book system. We are told that the project will be expanded during 2007 to include the private sector and we are hopeful that this will result in increased opportunity for the Foundation.
As a result of NICE publishing on its website in 2003 their review of this clinical development (the endoscopic approach to the treatment of chronic back pain), even fewer referrals than before have been allowed by PCT's. NICE's opinion and the associated anonymous comments have been vigorously contested by the Charity. As well as lobbying many MPs, The Trustees took legal advice and pressed NICE to review its published guidance. As a result, this was slightly modified in December 2004, but to no practical effect. A generous donor, a former patient, then obtained counsel's opinion that there was a basis for judicial review of the actions taken by NICE, but lack of funds has prevented the Trustees taking that matter further. However in March 2005 we have were advised that NICE has now been made accountable to the Heath Service's Commissioner and as a result a complaint has been made against NICE.
We have documented statements by PCTs that they believe they cannot refer to us because of the position taken by NICE. As a result this has caused the Charity further serious financial difficulty and further action has been taken to reduce costs during 2006 in line with the reduced income.
We are working closely with the NHS Clinical Trials Unit at York University in order to prosecute a multi-centre, International Randomised Controlled Trial of Endoscopic Lumbar Decompression versus Transforaminal Lumbar Instrumented Fusion. We hope this will commence in the early part of next year.
The financial projections for 2006/7 show that with the further recent reductions in expenditure, other changes made by the Trustees, the prospect of increased referrals and projected donations and fund raising from planned events, sufficient funds will be available for the coming financial year.
The incoming resources for the year are set out in the statement of financial activities on page 8.
FINANCIAL REVIEW
Policy on research
The policy remains to vigorously pursue and promote research in the field of Minimally Invasive Spinal Surgery. A considerable effort is made to maintain a rigorously audited and extremely detailed database of patients' problems, their treatments and the outcomes of their treatments. The quantity and quality of this data and of the successful research proposal submitted by the Foundation to the Department of Health is a credit to the staff supported by the Charity. Links are continuously maintained with international organisations pursuing research in this field and to promulgate the potential benefits for patients.
Trustees' responsibilities
The law applicable to charities in England/Wales requires the Trustees to prepare financial statements for each financial year which give a true and fair view of the state of affairs of the Charity and of the surplus or deficit of the Charity for that period. In preparing those financial statements the Trustees have:
- selected suitable accounting policies and applied them consistently
- made judgments and estimates that are reasonable and prudent
- stated whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the financial statements; and prepared the financial statements on a going concern basis (unless it is inappropriate to presume that the Trust will continue in operation).
The Trustees have overall responsibility for ensuring that the Charity has an appropriate system of controls, financial and otherwise. They are also responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the Charity and enable them to ensure that the financial statements comply with the Charities Act 1993. They are also responsible for safeguarding the assets of the Charity and hence for taking reasonable steps for the detection and prevention of fraud and other irregularities.
Auditors
A resolution proposing that Horwath Clark Whitehill LLP be reappointed as auditors of the Charity will be put to the Annual General Meeting.
This report was approved by the Trustees on 17 January 2007 and signed on its behalf, by:
S.J. Keyworth, Acting Chair