Annual report and accounts 2006

David Carter, Chairman, The Health Foundation

Achievements and performance

The Health Foundation’s ambition is to help shape a future health system that provides safe, reliable and effective patient care. Using our independence and investments judiciously, we are bringing together the best combination of local, national and international expertise towards this goal. Calendar year 2006 was in many respects a spectacular year. Behind the £25.5 million expenditure for the year lies a story about early successes, important learning and expanding influence.

Working with a range of partners, from international experts to front-line healthcare staff, the breadth and scope of our activities in 2006 took us significantly further than we anticipated on the journey towards high quality healthcare. During the year, we began reporting early results from an expanding portfolio of programmes, generating positive interest from across the health sector. This mounting enthusiasm for our initiatives successfully demonstrates how a focus on quality improvement can capture the hearts and minds of health professionals and build on their intrinsic motivation to provide the best care to patients.

Significant new initiatives were developed and launched in 2006. Highlights include an online Quality Information Centre, which was created as part of our Quest for Quality and Improved Performance (QQUIP) research initiative; making awards to six new Clinician Scientists; and commencing an innovative quality improvement initiative in Malawi to address the problem of maternal mortality. In an effort to spread innovation, we designed the second phase of our Safer Patients Initiative and our new scheme, Engaging with Quality in Primary Care, and selected sites and technical partners for each.

We evaluated our Leaders for Change, Quality Improvement Fellows, and Harkness Fellowship schemes and approved a final Shared Leadership scheme to focus on Black and Minority Ethnic populations. Towards the end of the year we agreed the final stages of development for a radically new and ambitious scheme in Patient Engagement, called the Co-creating Health Initiative.

A number of activities exceeded our expectations. For example, early results from our Safer Patients Initiative sparked strong interest from healthcare providers, politicians and policy makers for more concerted action to address safety problems right across the NHS. We anticipate that this interest will continue in 2007. In addition, our first briefing about the Engaging with Quality Initiative stimulated interest in clinical outcomes measurement and the role of clinical audit in improving the care patients receive. Evidence from the work we fund has also been used to respond to government policy consultations on the development of healthcare commissioning in England and the regulation of health professionals.

Throughout the year we developed a greater understanding of our field of endeavour – to learn more about the factors, both system-related and human, that contribute to better healthcare quality. Early indications confirm we are working in an emerging field of enquiry and practice, and we are now more aware of the gaps in knowledge. Nonetheless, the first reports from our QQUIP research initiatives about the challenges associated with quality improvement have generated significant interest from health professionals, policy makers and academics alike.

Working in this new field also challenged our internal capacity to deliver an ambitious agenda. To improve our capacity to manage our programmes, many of our staff with well-developed skills in grant-making and project management had to develop knowledge and experience directly relevant to improving the quality of health care. In response, we introduced a corporate learning programme on health services and began a research and development strategy to increase our internal capacity to keep abreast of rapidly changing issues in healthcare. We also restructured the Programmes and Policy Directorate.

The vast majority of planned 2006 business activity was achieved, and we were unable to fulfil only a small number of commitments. We struggled to recruit the right high calibre senior staff to deliver some of our plans. Other plans were simply overshadowed by the demands of managing our large demonstration initiatives. Plans that slipped included several research and development projects, the creation of a quality network and the redesign of our website.

Our activities and achievements in 2006 demonstrate how the Health Foundation is uniquely positioned to broker across policy, practice and research communities. We are searching worldwide for the best knowledge and practices about quality improvement; working with talented health professionals and patients to apply this knowledge and improve the delivery of healthcare; and identifying, teaching and spreading the skills and methods that produce better care.

This was the first year where early results from several of our initiatives emerged, and it’s clear we are already extending our influence. A nascent groundswell of enthusiasm and interest in quality improvement is growing, particularly with regards to patient safety, and we are starting to gain more partners on our journey towards high quality healthcare. We now have a strong base from which to build our future success.

See also 

• We are The Health Foundation
• Corporate publications

With its focus on improving healthcare quality, the Health Foundation is working in an emergent and potentially large field. For this reason The Health Foundation has commissioned an innovative programme of research about healthcare quality and performance.

Principal achievements for 2006:

• Publication of an initial set of reports and an online Quality Information Centre as part of the QQUIP research initiative.
• Dissemination of information about how to improve quality and performance in healthcare to a range of healthcare decision makers, especially policy makers. 
• Sharing information about quality and performance internationally, including hosting an international quality exchange meeting.

Quest for Quality and Improved Performance

Our major five-year, £2.5m research initiative, Quest for Quality and Improved Performance (QQUIP) produced an initial set of reports during 2006. These enabled us to contribute evidence to policy debates about healthcare regulation, “value for money” in the NHS and strategies for engaging patients for better quality care. The principal investigators for QQUIP are Sheila Leatherman (University of North Carolina School of Public Health), Kim Sutherland (Judge Business School, University of Cambridge), Peter Smith (University of York) and Gwyn Bevan (London School of Economics and Political Science).

In December 2006 we launched a Quality Information Centre as part of the QQUIP website. The website brings together data from a wide range of sources to reveal national and international trends on diseases and quality of care. It also collates evidence on the impact of various interventions designed to improve the quality of healthcare internationally. When launched it contained over 150 charts which provide easily accessible, at-a-glance data on priority areas such as cancer, heart disease, diabetes and mental health. We will continue to collect analyse and update the data, which come from a wide range of already published and publicly available sources.

Additional dissemination activities included using QQUIP reports to engage high-level policy stakeholders in round table discussions. We attracted interest from the Department of Health, Treasury, Healthcare Commission, National Audit Office, Audit Commission, Monitor, and the Academy of Medical Royal Colleges, among others. The trade media were particularly interested in the “value for money” report. A paper about the evidence on effective regulation of doctors by Leatherman and Sutherland was published by the British Medical Journal.

• Visit the QQUIP website
  

2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians

This is the third year we paid for both an expansion of the sample size of the annual Commonwealth Fund International Health Policy Survey and an in-depth analysis of its implications for the UK’s four countries. This year’s survey examined the attitudes and experiences of GPs in providing primary care. Delays in the recruitment of GP respondents meant a delay in the additional UK specific analysis we commissioned. A report from the National Primary Care Research and Development Centre (University of Manchester) is now expected in early 2007.

• Read the full report
  

International Quality Improvement Exchange

We co-hosted with The Netherlands Organisation for Health Research and Development (ZonMw) a second annual international quality improvement exchange. Forty healthcare leaders from eight European countries attended the event in December, which provided a neutral forum for debate between policy makers, academics and service providers in countries already engaged in quality improvement activities.

• Read the full report
  

Utilising research evidence to improve quality

In 2006 several strands of the new NHS Research and Development Strategy were implemented, including a further significant expansion in the resources available to the National Co-ordinating Centre for NHS Service Delivery and Organisation Research and Development. Therefore, we supported two small initiatives to promote links between health services researchers and clinicians and managers: the NHS Confederation Health Services Research Network and a quality improvement “community of interest” in the NHS called “Contact, Help, Advice and Information Networks” or CHAIN.

We had planned to commission a range of context setting research and development projects and reports which would help us explore in more detail some of the factors that impact on improving the quality of care in the UK. Unfortunately, the difficulties we have experienced in recruiting senior staff meant that we did not have the internal resources to undertake this work. We are exploring a range of options for undertaking these activities in 2007.

Healthcare Leaders Panel

Due to difficulties recruiting public affairs staff, we did not conduct opinion research through our Healthcare Leaders Panel. Moreover, with commissioned research and indeed our programmes now producing results, undertaking opinion research in this way was deemed less suitable as a way of understanding healthcare quality and performance.

The aims of the Health Foundation’s Leadership Programme are: to test out and evaluate approaches to developing leaders in health and contribute to the development and dissemination of knowledge about leadership in healthcare; and to explore and explain the relationship between leadership and quality improvement.

Principal achievements for 2006:

•  We ran a portfolio of eight leadership development schemes, both for individual leaders and healthcare teams.
• Two new shared leadership schemes were designed for launch in 2007.
• Internal evaluations have led to important modifications to our schemes. Their findings were used to influence policy makers responsible for leadership programmes elsewhere.

We believe that effective, skilled leaders lie at the heart of lasting improvements in the quality and safety of healthcare. Healthcare professionals from a wide range of organisational and professional backgrounds are participating in our leadership development schemes. The schemes are work-focussed and relevant to the real situations, problems and challenges participants face. Our schemes are offered free of charge and are highly competitive.

During 2006 we ran eight leadership development schemes, and undertook extensive preparation for a further two, which will be launched in 2007.

Our portfolio of leadership schemes includes:

For individuals:

• Leadership Fellows
• Quality Improvement Fellows
• Leaders for Change
• Health Foundation/Harkness Fellowships in Health Policy
• Clinician Scientists

For teams (shared leadership):

• Shared leadership for change: Diabetes.
• Shared leadership for teams participating in the Safer Patients Initiative and the Engaging with Quality Initiative.

In 2006 we recruited high quality applicants to all five individual leadership schemes: 16 Leadership Fellows, 14 Leaders for Change, 6 Clinician Scientists, 2 Quality Improvement Fellows and 2 Harkness/Health Foundation Fellows. Furthermore, we made considerable progress in involving leadership award holders in the Foundation’s policy influencing and media work.

Since 2004, 138 clinicians, NHS managers, academics and policy makers have received leadership development support through one of our eight leadership development schemes. Some of them were involved in action learning sets and master classes, some had personal coaching or a mentor, some undertook service improvement projects or research studies, and others participated in structured courses. The schemes varied in their focus: some emphasised interpersonal skills, others focussed on subject expertise, some on quality improvement science, and some looked at organisational culture, power and politics. The duration of each award ranged between one and five years.

Our leadership schemes are delivered by a set of high quality providers of leadership development. Regular meetings with these providers and increasingly robust quality assurance systems ensure that those delivering our schemes fully understand the Foundation’s objective of leadership development for quality improvement.

This year we conducted an internal evaluation of the extent to which the different schemes were effective in developing the skills of leadership for quality improvement. The study led to adjustments to our schemes and ensured alignment with the Foundation’s core purpose of quality improvement. We also used the study’s findings to inform the development of leadership programmes elsewhere, such as NHS Institute for Improvement and Innovation, and to stimulate debate among policymakers through the media. For instance, the study found that if quality improvement is the desired goal, then the leadership development activities must be structured deliberately to support that goal.

Our pioneering shared leadership support to teams tackling problems in safety and quality has enabled us to identify the conditions required for success. For example, we learned from the Diabetes teams that skills for measuring improvement needed support. Learning through formal evaluation, feedback from our leadership consultants and teams, and our own management has led to adjustments to schemes in progress.

Our early learning also informed the design of new shared leadership initiatives: Engaging with Quality (Primary Care) and Shared Leadership (BME). The latter will demonstrate how shared leadership principles can be used by health teams charged with reducing health inequalities. A Reference Group of experts drawn from a wide range of backgrounds was convened, and two further meetings are planned to advise on scheme design before it launches in 2007.

Limited progress was made in developing a sustainable network of individual leadership award holders after they have completed their awards. Nonetheless, we reaped the benefits of a growing number of accomplished ‘alumni’ on whom the Foundation can draw for expertise, and who will be a resource for building future capacity for quality improvement across the healthcare system.

Elsewhere, we supported the Department of Health’s plans to create an Emerging Leaders Network across England, and were disappointed when the project was terminated at a late stage in development.

Close relationships with two Directorates at the NHS Institute for Improvement and Innovation, Leadership and Learning have borne fruit. We supported the NHS Management Training Scheme’s 50 Years Anniversary Conference in September, both financially and in terms of membership of the steering group. We advised on a new NIII Fellowship scheme for clinical leaders ensuring learning from Quality Improvement Fellows was incorporated into the design of the scheme.

Three publications, all in the Guardian’s Public monthly magazine, explained the Foundation’s Leadership work. We also supported a successful Health Services Journal Conference on Leadership, where two of the Foundation’s Leadership schemes, Quality Improvement Fellows and Shared Leadership for our Safer Patients Initiative, were featured.

• Find out more about our leadership schemes
  
• Publication: Leading for better healthcare
• Mulitimedia: watch our video featuring leadership award holders

Demonstrating how to improve Patient Safety in hospitals is currently the single focus of the Health Foundation’s efforts to improve the performance of healthcare organisations. Working with the renowned Institute for Healthcare Improvement, participating hospitals in our Safer Patients Initiative are learning how to create safer healthcare.

Principal achievements for 2006:

• The four hospitals participating in the first phase of our Safer Patients Initiative reported significant improvements in patient safety after two years of hard work.
• The early results of the Safer Patients Initiative captured the imagination of policymakers, and contributed to government-led plans and debate about improving patient safety across the UK
• The Safer Patients Initiative was expanded to include 20 new sites, following a competitive selection process.

September 2006 marked the first two years of the £4.3 million Safer Patients Initiative (SPI phase 1). During this period the four hospitals participating in the initiative reported significant improvements in patient safety. Highlights include achieving reductions in the number of adverse events, reducing the number of cardiac arrests by improving care on general acute wards, improving compliance with hand hygiene and reducing infections and length of stay on intensive care units. Other achievements include improved care on surgical wards and improved medicines management. Late in 2006 the initiative has entered its second two-year stage: developing the sites as exemplars, working to sustain their improvements and help others achieve similar changes.

Throughout 2006 the teams involved in the SPI made presentations at national and international conferences, helping to raise the profile of patient safety across the UK and internationally. Some of the early lessons included:

• What types of data need to be collected and what measurement systems need to be in place for front line staff to make safety improvements.
• Patient Safety must be a strategic priority for the hospital board and senior executives. Chief Executives have an important role in creating a culture that supports safer care.
• There is a dearth of knowledge about how to implement improvements, and staff need support to develop skills and to learn techniques.
• Leadership development is crucial for embedding quality improvement.

The success of our SPI generated a strong interest amongst the Chief Medical Officers and other senior officials in the Departments of Health in England, Wales and Scotland. The Foundation’s senior staff used knowledge gained from running the SPI to contribute to the emerging plans and debate about improving patient safety in the UK.

A second expansion phase for the SPI was developed and launched in November 2006. Using a competitive process, we selected 20 hospitals from across the UK to work in pairs to bring about similar safety improvements. We expect these hospitals to benefit from the learning from the first phase, and to apply and accelerate safety improvements throughout their organisations. The four initial sites along with our partner, the Institute for Healthcare Improvement, will support the initiative’s expansion.

The research consortium led by Professor Richard Lilford, Professor of Clinical Epidemiology at the University of Birmingham, completed its first year of the evaluation of SPI phase one. The externally commissioned evaluation comprises three studies: the use of staff and patients survey material to capture a range of organisational attributes and how these organisations compare against others; a qualitative study of stakeholders within the hospital sites; and a medical record case note review of adverse events. We will continue to receive annual interim reports up until the final report in 2009.

To understand the key factors that are involved in helping healthcare organisations transform their approach to patient safety, we also commissioned Professor Charles Vincent, Professor of Clinical Safety Research at Imperial College London, to undertake a five-year research project examining the characteristics of high reliability and patient safety, identifying the key practical steps that healthcare organisations can take to improve safety and mapping the “journey to safety”. Throughout, Professor Vincent will work with us to align his research with the work of the Foundation.

The Foundation is also working with the World Health Organisation’s World Alliance for Patient Safety, supporting their efforts to identify common elements that enable healthcare organisations to transform their thinking and approach to improving patient safety. With the OECD, we published an article on comparative patient safety indicators in a professional journal.

• Find out more about the Safer Patients Initiative
  

The underlying rationale for the Health Foundation’s engaging clinicians programme is that unless clinicians are fully engaged in efforts to improve quality we will never achieve the full potential of improvements. We are working with Royal Colleges and other professional organisations to develop the expertise and leadership required for stronger clinical engagement.

Principal achievements for 2006:

• The project teams participating in our Engaging with Quality Initiative made progress in recruiting clinicians to their clinical audits, and some began using their data to generate improvements in patient care.
• We launched a second major demonstration programme, Engaging with Quality in Primary Care, and made awards totalling £4.3m to nine projects.
• We began campaigning about the importance of measuring clinical quality in relation to current health policy sharing our perspectives with government and other policy makers.

Through our £4.5million Engaging with Quality Initiative, we continued to support nine projects designed to close the gaps between current and best practice in hospital care. Working through Royal Colleges and other professional organisations, the initiative is supporting eight multidisciplinary teams, which include patients or their representatives.

These teams have set up and are running systems for measuring the quality of clinical care. They are then using the performance data to develop ways to support local service improvements. During 2006, the teams received leadership training and shared online resources. Through events and master-classes, the teams learned from each other and from national and international experts. An evaluation is underway, led by a consortium of RAND Europe and the Health Economic Research Group (HERG) at Brunel University. The evaluation team has provided considerable advice and support to each project team.

During 2006 the award holders completed the first phase of their project, setting up and piloting clinical quality measurement systems and moved on to the second phase, recruiting clinical services throughout the country to participate in the projects by contributing data and preparing to put into place improvements in clinical care.

A number of the EWQI project teams exceeded their targets for recruiting clinicians to participate in projects. Amongst the most successful are the two projects run by the Royal College of Psychiatrists, one aiming to improve prescribing of drugs for service users with serious mental health problems and one to improve services for patients who self harm. The Royal College of Physicians signed up 90% of acute trusts to their audit of inflammatory bowel disease. Unfortunately, not all projects achieved the same success in terms of participation and overall progress.

• Find out more about the Engaging with Quality Initiative
  

During 2006 we ran a competition for awards for our second major demonstration scheme in the ‘engaging clinicians’ programme, Engaging with Quality in Primary Care. In December awards totalling £4.3m were made to nine projects. All projects will seek to fill the gap between the current and best practice in primary care. They are led by primary care clinicians, and patients and their carers are involved in the direction and implementation of each of the projects.

We appointed the Improvement Foundation to run a development programme for the award holders. The programme will cover technical quality improvement and leadership development. On value for money grounds we appointed the same consortium to evaluate the Engaging with Quality in Primary Care award scheme, and we anticipate significant synergies between the two studies.

We identified a number of policy issues arising from the engaging clinicians programme and used these to build support for measuring clinical quality. The issues emerging from the projects were:

• the importance of timely measurement of the outcomes of care to guide future improvement efforts;
• conflict between policies promoting autonomy for clinical professionals and healthcare providers and the need for comparative clinical quality measurement in the public interest;
• the unstable and inadequate funding base for essential national systems for measuring clinical quality; and
• the need for more support for the development of improvement methodology and leadership skills in healthcare teams.

A formal policy briefing about the Engaging with Quality programme was produced to raise awareness of the importance of clinical quality measurement and to argue for more resources nationally to support clinical measurement activities. We disseminated the briefing, held a series of meetings with senior government officials and civil servants, and hosted fringe meetings at the political party conferences to promote our messages. These policy messages were also incorporated into our consultation responses to the Department of Health’s “Our health, our choice” and commissioning consultations, the Chief Medical Officer’s report, “Good Doctors, Safer Patients”, and our formal submissions to separate health policy consultations conducted by the Conservative and Liberal Democrat political parties.

In addition, we explored with the Department of Health and the Healthcare Commission how participation in the quality improvement activities funded by the EWQ scheme could be used by NHS Trusts in England as evidence of compliance with developmental standards in the annual ‘health check’ of NHS providers. We also sought their continued financial support for national clinical audits because we remain concerned about the long term sustainability of these programmes.

During the second half of the year we prepared to undertake qualitative research (to be commissioned in 2007) that explores clinicians’ and managers’ understanding and experiences of quality improvement. For this purpose, a literature review was carried out by Professor Huw Davies and colleagues of St Andrew’s University into what is known about the attitudes of clinicians and managers to quality improvement.

• Find out more about Engaging with Quality in Primary Care

The underlying rationale for the Health Foundation’s patient engagement programme is that optimum health and healthcare can only be achieved if patients are supported to play a more active role in improving their own health. The Foundation is actively testing ways of engaging patients in the production of better health outcomes.

Principal achievements for 2006:

• The Quality Improvement in Malawi initiative was launched to improve maternal and neonatal morbidity and mortality.
• A self-management demonstration, the Co-creating Health initiative, was designed and a “call for proposals” issued.
• A tender process for the technical providers for the Co-creating Health initiative was undertaken.
• An international seminar on the role of healthcare professionals in self management was held.

Quality Improvement in Malawi

February 2006 saw the launch of the Foundation’s new Quality Improvement in Malawi initiative. To mark the launch, events were held in the UK and Malawi, with the High Commissioner of Malawi in the UK and the Permanent Secretary of the Malawi Ministry of Health attending respectively. The aim of the initiative is to measurably reduce maternal and neonatal morbidity and mortality in Malawi over a period of three years. The initiative spans three districts with a combined population of around two million. The Foundation’s work in Malawi is delivered via a consortium of technical providers known as “The Health Foundation Malawi Consortium”, which includes the Institute for Healthcare Improvement, Liverpool Associates of Tropical Health and Women and Children First. Managing the project through the consortium demanded greater attention from Foundation staff than anticipated. By September 2006, the full operational team had been successfully recruited and established, consisting primarily of Malawian citizens.

Between May and November 2006, nine hospitals within the three districts had joined the quality improvement programme with the specific aim of reducing maternal mortality by 50%. Two quality improvement workshops were held to share experiences and to learn from each other as well as from invited experts. During 2007, the quality improvement work will spread to health centres within the three districts. Facility-based work will be complemented by education and community mobilisation through village-based women’s groups. Finally, the projects’ evaluation will undertake a baseline survey early in 2007, giving the current maternal and neonatal mortality levels, which are believed to be among the worst in the world.

• Find out more about Quality Improvement in Malawi
  

Co-creating Health: a Self Management Initiative

Throughout 2006, we designed our first major patient engagement demonstration project in the UK, the Co-creating Health Initiative. Its aim is to demonstrate that self-management by people with long-term conditions, appropriately supported, leads to improved health outcomes. The initiative consists of three interventions; an advanced development programme for clinicians, a self management course for people with long term conditions and redesign of services in order to facilitate self-management. The Health Foundation is investing £4.95 million in this initiative over three years.

Technical providers for each of the three interventions were sought through an international competitive tendering process. The advanced development programme for clinicians will be provided by Client-Focussed Evaluations Program UK, working with Dr Larry Baker and Dr Michael Goldstein. The self-management course for people with long term conditions will be provided by the newly formed Expert Patients Programme Community Interest Company. The service re-design element of the initiative will be provided by Finnamore Management Consultants. A team from the University of Coventry was selected to conduct the evaluation in January 2007.

In November 2006, organisations from across the UK were invited to apply to participate in the Co-creating Health Initiative. Applications will be assessed in Spring 2007, with successful sites announced in June.

• Find out more about Co-creating Health

The role of the Health Professional in Supporting Self-Management

In July 2006, the Foundation, with the support of the Department of Health (England), convened and ran a workshop to raise awareness about supported self-management with the British medical education community.

We have audited the financial statements of The Health Foundation for the year ended 31 December 2006 which comprise the Statement of Financial Activities, the Balance Sheet, the Cash Flow Statement and the related notes set out on pages 42 to 53. These financial statements have been prepared in accordance with the accounting policies set out therein.

This report is made solely to the charitable company’s members, as a body, in accordance with section 235 of the Companies Act 1985. Our audit work has been undertaken so that we might state to the company’s members those matters we are required to state to them in an auditors’ report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the charitable company and its members as a body, for our audit work, for this report, or for the opinion we have formed.

Respective responsibilities of the trustees and auditors

The responsibilities of the trustees, who are also the directors of The Health Foundation for the purposes of company law, for preparing the Trustees’ Report and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice) are set out in the Statement of Trustees’ Responsibilities on page 30.

Our responsibility is to audit the financial statements in accordance with relevant legal and regulatory requirements and International Standards on Auditing (UK and Ireland).

We report to you our opinion as to whether the financial statements give a true and fair view and are properly prepared in accordance with the Companies Act 1985 and whether the information given in the Trustees’ Report is consistent with the financial statements.

In addition we report to you if, in our opinion, the charitable company has not kept proper accounting records, if we have not received all the information and explanations we require for our audit, or if information specified by law regarding trustees’ remuneration and other transactions with the charity is not disclosed.

We read the Trustees’ Report and consider the implications for our report if we become aware of any apparent misstatements within it.

Basis of opinion

We conducted our audit in accordance with International Standards on Auditing (UK and Ireland) issued by the Auditing Practices Board. An audit includes examination, on a test basis, of evidence relevant to the amounts and disclosures in the financial statements. It also includes an assessment of the significant estimates and judgments made by the [trustees] in the preparation of the financial statements, and of whether the accounting policies are appropriate to the charitable company’s circumstances, consistently applied and adequately disclosed.

We planned and performed our audit so as to obtain all information and explanations which we considered necessary in order to provide us with sufficient evidence to give reasonable assurance as to whether the financial statements are free from material misstatement, whether caused by fraud or other irregularity or error. In forming our opinion we also evaluated the overall adequacy of the presentation of information in the financial statements.

Unqualified opinion

In our opinion:

• the financial statements give a true and fair view, in accordance with the United Kingdom Generally Accepted Accounting Practice, of the state of affairs of the charitable company as at 31 December 2006 and of its incoming resources and application of resources, including its income and expenditure, for the year then ended;
• the financial statements have been properly prepared in accordance with the Companies Act 1985; and
• the information given in the Trustees’ Report is consistent with the financial statements. 

Horwath Clark Whitehill LLP
Chartered Accountants and Registered Auditors
St Bride’s House
10 Salisbury Square
London
EC4Y 8EH

June 2007

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Statement of financial activities

Balance sheet

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