Red Cross Report

2011 Trustees’ report and accounts Patron Her Majesty The Queen President His Royal Highness The Prince of Wales KG KT GCB OM Deputy presidents Her Royal Highness Princess Alexandra The Hon Lady Ogilvy LG GCVO The Countess Mountbatten of Burma CBE CD JP DL Honorary vice-presidents Lord Barnard TD The Rt Hon Baroness Chalker of Wallasey Sylvia, Countess of Limerick CBE Professor John McClure OBE Mrs Elspeth Thomas CBE DL Vice-presidents Mr Anthony Andrews Ms Angela Rippon OBE Mrs Maria Shammas MBE Board of trustees Chairman Mr James M. T.Cochrane Vice-chairmen Mrs Victoria Peterkin Mr David Fall CMG Mrs Stella Cummings (from January 2012) Treasurer Mr Russell Walls (until September 2011) Mr David Howell (from September 2011) Other trustees Mrs Sue Brown Mr Stanley Fitches MBE Ms Amy Foan Mr Christopher Hedges (until December 2011) Mr Michael Herriot MBE Mr Steve John Mr Afzal Khan CBE (until October 2011) Lady Lamport Dr Lise Llewellyn Mr Gordon Low Dr J. Kay Richmond (until De cember 2011) Mr Graham Stegmann CBE Mr Paul Taylor (from January 2012) Mr Keith Shipman (from January 2012)Senior management team Chief executive Sir Nicholas Young Managing director of operations Michael Adamson Director of international David Peppiatt Director of UK service development Margaret Lally UK director, Scotland, Northern Ireland and the Isle of Man Territory Norman McKinley UK director, Northern Territory Jean Henderson UK director, Wales and Western Territory Annie Bibbings UK director, South Eastern Territory Liz Page Director of communications Philip Talbot Director of fundraising Mark Astarita Director of people and learning Roger Smith FCIPD Chef de cabinet Caroline Leighton Director of finance and business development Rohan Hewavisenti Sub-committees Finance and audit committee Mr David Howell, chairman (from September 2011) Mr Russell Walls, chairman (until September 2011) Mr James M. T. Cochrane Mr Stanley Fitches MBE Mr Gordon Low Mrs Liz Hazell Mr Anthony Pott s Mr Peter Bluck Remuneration committee Mr James M. T. Cochrane, chairman Mr Russell Walls until September 2011) Mr David Howell (from September 2011) Mrs Victoria Peterkin Mr David Fall CMG Ethical review panel Mrs Stella Cummings Mr Steve John Mr Graham Stegmann CBE External auditors BDO LLP Emerald House East Street Epsom Surrey KT17 1HS Bankers National Westminster Bank plc City of London Office PO Box 12258 1 Princes Street London EC2R 8PA Investment managers Lazard Asset Management Ltd 50 Berkeley Street London W1J 8HA Legal & General Investment Management One Coleman Street London EC2R BlackRock 33 King William Street London EC4R 9AS External legal advisers Withers 15 Old Bailey London EC4M 7EG Young mother Pearl, 21, became a volunteer after she and her extended family received support from the Red Cross in South Africa 1 ContentsChairman and chief executive’s statement Our aims Emergency response Health and social care Building resilience: first aid and humanitarian education Plans for 2012 Review of finances Structure and governance Independent auditors’ report to the trustees of the British Red Cross Society 4 5 6 8 10 12 14 16 19 22 44 I don’t think I could have managed. To know I could always pick up the phone and talk with Sue made the world of difference Volunteer Sue Whalley helped Ellis Sheldon and his wife cope with illness in their remote country home Accounts for the year ended 31 December 2011 Thank you 2 British Red Cross Trustees’ report and accounts 2011 3 Chairman and chief executive’s statement This year has shown us how easy it is for a movement of people to change the world, for good or ill.Summer riots in the UK, financial protests around the world and the fall of governments in the Middle East and Africa – they all relied on an instantly connected network of people acting as one, quickly and powerfully. Part of the Red Cross’ mission is to mobilise the power of humanity. If chaos an d violence are unfolding more quickly, then so must our ability to harness that power for good, saving and changing lives in the UK and overseas. As always, our volunteers and staff were at the sharp end of crisis around the world last year, from drought and famine in east Africa to severe weather in Scotland. We remain realistic about the external pressures and challenges facing us.A key focus for us has been the way the coalition government’s reforms and reviews are affecting our work – most notably the NHS reforms, cuts in the public sector and the Department for International Development (DFID) aid reviews. We have continued to develop our health and social care offer to be more consistent, integrated and focussed on what NHS commissioners’ needs are likely to be in the future. This is just one way we are making sure that our services are available for people adversely affected by changes or cuts. We also obtained unconditional registration for our ambulance work from the Care Quality Commission, which ensures we can continue to deliver a variety of ambulance services independently across England.In November we transferred our skin camouflage service to a new home at Changing Faces, a charity specialising in disfigurement. Over the last 36 years, this award-winning service has helped tens of thousands of people cope with disfiguring conditions and blemishes and Changing Faces is well placed to develop the service further, ensuring it continues to have a great impact on people’s lives. We offer our thanks to the dedicated and skilled volunteers and staff involved. The DFID aid reviews, and the work of the devolved administrations, have shown an increasing focus on preparing for emergencies in the UK and overseas, which represents a significant opportunity for us.Our ‘Ready for Winter’ campaign to ensure that people are prepared for severe weather, launched in partnership with the Scottish government, is a good exampl e of how we are meeting it. In these financially challenging times, we must make sure we maximise our fundraising potential to ensure our financial sustainability. Our compact with our supporters is that, as ever, we will keep our costs under control and make efficient and effective use of all our resources. We, and the more than a million people we help each year, rely on their generosity and trust. Thank you to all of our supporters, partners, volunteers and staff members for their vital contributions in 2011 – working together, we saved and changed people’s lives around the world. Our aims Our vision is of a world where everyone gets the help they need in a crisis.Our mission is to mobilise the power of humanity so that individuals and communities can prepare for, deal with and recover from a crisis. As the UK’s leading emergency response charity, 3,500 staff and 32,500 volunteers pursue these goals both here and overseas. Our work includes emergency response , health and social care, and building resilience (including first aid and humanitarian education). We operate both in our own right, and as part of the International Red Cross and Red Crescent Movement, the world’s largest humanitarian network, which has around 13 million volunteers across 188 countries. Our corporate strategy, Saving Lives, Changing Lives, sets the framework for our core activities between 2010-15. redcross. org. uk/movement redcross. org. uk/strategyOur plans for 2011 included: > strengthening our ability to respond to large emergencies across the whole of the UK > strengthening the quality of our services for refugees and asylum seekers > increasing the reach and quality of the International Federation of Red Cross and Red Crescent Societies’ disaster response > establishing our care in the home activity as the main focus of our UK health and social care work, integrating existing services with it where appropriate > building resilience, helping pe ople and communities prepare for and withstand disasters. James M. T. Cochrane Chairman of the board of trustees I feel I’m not only helping individual people, but helping the Red Cross and society in general After being made redundant, Ed Owen found a new lease of life as a care in the home volunteer Sir Nicholas Young Chief executive 4British Red Cross Trustees’ report and accounts 2011 5 Emergency response When an emergency strikes, we respond We launched seven emergency appeals in 2011, raising ? 21. 6 million to help people in east Africa, Japan, New Zealand, Pakistan, Turkey, the Libya region and the Ivory Coast region recover from famine, conflict, flooding and earthquakes. As tens of thousands of people displaced by civil war in Libya fled across the border to Tunisia in March, we sent experts in logistics and mass sanitation to support the International Red Cross and Red Crescent Movement’s response there. This helped prevent the outbreak of disease and sickness in the displacement camps.We also sent logistics delegates to support the Movement’s operations during violent clashes in Egypt and the food crisis in Kenya to make sure vital aid got to the people who new cases opened to help separated families get back in touch 610 30,000 people in the UK given first aid at 9,000 public events needed it, even in the most challenging environments. Following January 2010’s devastating earthquake in Haiti, we are halfway through a four-year recovery programme. Over the last year, we have helped 75,000 people recover their livelihoods through cash distribution, provided water and sanitation where there was none, and given 22,000 families safe and improved shelter. We started to build permanent housing to replace transitional shelters. In he midst of the recovery process, we also responded to a major cholera outbreak, treating 9,000 patients and operating five clinics and oral hydration units. Staff and volunteers responded to 4 ,200 (440 in Scotland) emergency response call-outs in the UK in 2011, in support of the emergency services. These ranged from fires and power cuts to an improvised explosive device in Omagh. The Red Cross volunteers provide an invaluable service to people at a time of great emotional need and stress. When they are looking after the families, it means the firefighters have one less factor to consider Mike Burroughs, Devon and Somerset Fire and Rescue Service ?3 million released from our Disaster Fund to help people affected by conflict or disasters in the UK and overseas 6British Red Cross Trustees’ report and accounts 2011 When severe weather in Scotland in December cut off many vulnerable people in remote locations, volunteers worked around the clock to distribute relief and support the Scottish Ambulance Service. We completed various reviews to ensure we can draw in the right numbers of volunteers and equipment from across the UK to respond in the event of a large emergenc y. Around a third of our services for refugees and asylum seekers, which helped 35,000 people (570 in Scotland), 22,300 of them destitute, are now accredited by the Office of the Immigration Services Commissioner, giving external assurance of their quality.We plan for the majority to be accredited by the end of 2012. redcross. org. uk/emergencyresponse redcross. org. uk/recovery I like the Red Cross because they give us biscuits and are teaching us how to improve our health James Losiru, ten, one of the children for whom our school feeding programme in Kenya is making a difference 27,000 people in the UK helped by us in an emergency 7 Health and social care We help vulnerable people recover from health or social crises, and live with dignity and independence in their homes We helped 397,000 people in the UK (28,000 in Scotland) this year when they could not cope at home alone, many of them after a stay in hospital or facing the risk of being admitted.This helped them retain their in dependence, and reduced admissions to hospitals and residential or nursing care. For example, our medical equipment loan service in southeast Wales made it possible for 280 patients to be discharged from hospital, averaging a saving of at least three bed days per patient. Ninety-one per cent of our health and social care service users reported that their experience was either good or excellent. We also began working towards the ambitious target of reaching 40 per cent more people in the UK with our health and social care services by 2014. As part of this work, we agreed 26 new health and social care developments in 2011. 75,000As the government progresses its social care reform agenda, we submitted written evidence to the health select committee, and developed proposals which will form the basis of an advocacy programme in 2012 to embed the voluntary sector’s role in tackling the UK’s care crisis. We work in partnership with other members of the International Red Cross and Red Crescent Movement across 16 countries to help communities tackle health and social crises – from people living with HIV in South Africa to young people rebuilding their lives after conflict in Sierra Leone. For example, we support a Kyrgyzstan Red Crescent programme to help vulnerable women build their livelihoods and be aware of their rights. This work includes an advocacy element, which contributed to a change in the law this year, whereby marriage registration is now compulsory.Previously, traditional unregistered marriages had left women who had been left by their husbands with no legal rights or standing. wheelchairs loaned to people to help them stay independent I’m very happy for the Red Cross’ help as they taught me how to take care of the kids, demonstrating how to give the pills when they first started taking their treatment. They supported me until I knew what to do Patricia lives in South Africa and cares for her four grandchildren, aged bet ween one and four, all of whom have either HIV or TB 7,700 volunteers in the UK delivering health and social care 8 British Red Cross Trustees’ report and accounts 2011 redcross. org. uk/healthandsocialcare redcross. org. uk/uksocialcare ulnerable people in the UK used our transport service to reach medical appointments or get other help with daily life 34,000 Now I feel more confident about getting out – and it’s so nice not to be stuck in the house all the time Sight-impaired Brenda Hall, from Llanelli, was visited for several weeks by a volunteer to help build her confidence and remain independent 9 Building resilience: first aid and humanitarian education We make communities more resilient by teaching people how to save lives and encouraging them to take action to help others of our volunteers are aged 18-26 (6,600 volunteers in total) 20% people learned about humanitarian issues and international humanitarian law through our education programmes 183,300 370 ,000 eople in the UK took one of our first aid courses in 2011, 61,000 of whom were from vulnerable groups A survey we ran this year showed that just 3 per cent of the UK population would be willing to invest a couple of hours in learning first aid, and 64 per cent fear the responsibility of having first aid skills. So in September 2011 we launched Everyday First Aid, a free online resource providing the simplest way possible to learn basic life-saving skills. Featuring videos, animation and reallife scenarios, the resource has been viewed by 199,000 people since its launch and supplements our range of face-to-face training courses. Ninety per cent of people who have taken one of our first aid courses felt more confident in using first aidThank goodness I had completed the first aid course, as the knowledge was still fresh in my mind. I just stopped panicking and started to slap her back. In less than a minute she was okay again Sayma put her training from our first aid course for m inority ethnic groups in Edinburgh into practice when her threeyear-old daughter began to choke as a result; and 76 per cent were more willing to use those skills in an emergency. We followed this up with the launch of our first mobile app, so that Android, BlackBerry and iPhone users have access to the same life-saving information on the move. The app was downloaded 127,300 times in 2011 and 185,000 by March 2012.Over the summer, we continued our Life. Live It. campaign, aimed at equipping 11 to 16-year-olds with first aid skills. Through a cinema trailer shown before the final Harry Potter film, we showed 2. 6 million people how to save an unconscious person’s life by pushing them on their side and tilting their head back so their airway is clear. We also took the same message to youth festivals around the country, with a series of ‘silent disco’ events, reaching around 5,000 young people. redcross. org. uk/firstaid redcross. org. uk/everydayfirstaid redcross. org. uk/app 6. 4 million people learned about first aid from us through public or media campaignsI realised I’d basically have to save someone’s life, which was a bit of a shock early on a Wednesday morning While on her way to a GCSE English exam, Hannah Niesser used her first aid training to give chest compressions to a collapsed man 11 10 British Red Cross Trustees’ report and accounts 2011 Plans for 2012 In 2012 we have committed that: 1. We will ensure we are fully prepared to meet the potential emergency response challenges presented by a year of major activity in the UK, including the Olympics, Paralympics and Queen’s Diamond Jubilee. 2. We will grow investment in international disaster response and increase the reach and impact of resilience programming with International Red Cross and Red Crescent Movement partners, particularly in Africa and South Asia. 3.We will teach first aid to 354,000 young people and adults, so they are more able, confident and willing to help someone in a crisis. 4. We will further strengthen the quality of our services for refugees and asylum seekers by achieving OISC accreditation for the majority of our services and seek institutional funding to meet some of the needs arising from the significant budget cuts of partners in the refugee sector. 5. We will continue to develop our health and social care services so we are on course to reach 40 per cent more beneficiaries by the end of 2014 with a choice of services that increase their ability to live independently for longer. 6.We will further strengthen our ability to measure the outcomes and impact of our work in the UK and internationally. Everything happened so quickly – it was really scary – so it was really good to have those friendly faces around Volunteers were on hand to provide mother-of-two Holly Gunning with emotional support and practical advice after her home was struck by lightning 12 British Red Cross Trustees’ rep ort and accounts 2011 13 Review of finances The organisation continued to grow, with total expenditure in 2011 increasing 16 per cent from ? 199. 2 million to ? 230. 9 million. This was supported by a 4 per cent increase in our total income to ? 213. 8 million. from regular giving increasing 21 per cent to ? 41. 9 million.Charitable expenditure Our charitable expenditure increased by 20 per cent to ? 159. 2 million in 2011 with the increase mostly in our emergency response activities. Continued support for the Haitian earthquake programmes, along with cash transfers made to support the Japanese earthquake response, resulted in our international emergency response expenditure increasing 74 per cent to ? 45. 4 million. We also invested further in our UK emergency response activities, increasing expenditure by 18 per cent to ? 24. 5 million. Expenditure on resilience programmes has increased 7 per cent to ? 39 million with the principal increase being in our work with National Societie s in other parts of the world.Our health and social care work is primarily UK-based and our expenditure on this activity decreased slightly to ? 41. 3 million. Expenditure on medical equipment services decreased by ? 3. 5 million to ? 12. 7 million due to the loss of a major contract for the provision of community equipment. This was offset by a ? 3. 4 million increase in our care and support programmes. Fundraising Voluntary income, which includes income from emergency appeals, fundraising, regular giving, cash donations and legacies, increased 10 per cent from ? 119. 9 million to ? 131. 5 million. Our individual supporters donated more than ever before, throughout challenging economic times, with incomeCharitable income Around 25 per cent of total income comes directly from charitable activities including first aid training fees, health and social care contracts and grants to support our international work. Our charitable income decreased 8 per cent to ? 52. 9 million, due to the loss of a major community equipment contract as well as a drop in grants to support our international work. Reserves Our reserves policy is set to ensure that there is no disruption of British Red Cross services in the event of an unforeseen reduction in income or increase in expenditure. The policy sets our minimum free reserves level at ? 15 million. As at 31 December, our free available reserves amounted to ? 41. 4 million (2010: ? 54. 7 million).We have changed many of our investments from equity to bonds to reduce the effects of market volatility on us. Together with tighter financial forecasting and reporting, this will enable us to plan for a lower level of reserves, allowing us to spend more helping people in need. This is consistent with our strategy, Saving Lives, Changing Lives, which outlines plans to draw down on our free available reserves by 2015. We plan to draw down ? 14. 8 million of reserves in 2012 and a further ? 6. 2 million in 2013. Pensions The British Red Cr oss operates two defined benefit pension schemes, which are both closed to new members. The net pension surplus reported in our accounts is ? 0. 7 million as at 31 December 2011 (2010 surplus: ? 1. million) and We prepare vulnerable groups, including women and children, for cyclones in Char Padma, Bangladesh the actuarial loss during the year was ? 1. 6 million (2010: ? 2 million gain). However, our latest actuarial valuations for funding purposes showed a net deficit of ? 4. 4 million. We also have contingent liabilities in relation to the membership of the Pension Trust’s Growth Plan. The British Red Cross has sole liability for ? 6. 5 million and joint liability with the Order of St John for estimated ? 3 million pension liabilities of the Joint Committee of the Order of St John of Jerusalem and British Red Cross Society. Investments As at 31 December 2011, we held fixed asset investments of ? 49. 1 million (2010: ? 58 million).Our investments reported net losses of ? 0. 6 million in 2011. An investment sub-committee of the finance and audit committee regularly reviews our investment portfolio and performs an annual review of our investment policy. Our investment objective is to seek yield subject to a requirement of capital preservation. The investment sub-committee has reviewed, and is satisfied with, the overall performance of the investment portfolio against its benchmarks. The British Red Cross will not directly invest in shares in, or commercial paper issued by, companies with a significant interest in the trading of arms or in the manufacture of tobacco products.However, it is recognised that the ethical investment policy cannot be applied when investing in pooled money market or investment funds. 14 British Red Cross Trustees’ report and accounts 2011 15 Structure and governance Legal status The British Red Cross was founded in 1870 and incorporated by Royal Charter in 1908. A Supplemental Royal Charter took effect on 1 January 1998 an d this was revised by HM the Queen in Council on 17 July 2003. The governing instruments under which the British Red Cross operates comprise this revised charter, the standing orders and other policies agreed from time to time by its governing body, the board of trustees.The legal objects of the British Red Cross, as laid out in its revised Royal Charter, are to provide assistance to victims of armed conflicts and to work for the improvement of health, the prevention of disease and the prevention and alleviation of human suffering in the UK and throughout the world. Organisation The board of trustees comprises nine elected members and up to eight members co-opted by the board itself. Newly elected and appointed trustees join the board at the start of the calendar year in most instances. Their terms of office last for three years, and they can serve two consecutive threeyear terms, after which they must stand down from the board for at least one year. A nominations group oversees rec ruitment of co-opted trustees. The recruitment of elected trustees is conducted via a national electoral college of eight volunteer council chairs. The board of trustees ratifies the result.The finance and audit committee oversees the organisation’s financial transactions. This committee has been given specific responsibilities and makes relevant recommendations to the board. While the approval of policy is a matter for the board, that body works closely with the chief executive and his colleagues on the senior management team, which is charged with the implementation of policy. A wholly-owned trading subsidiary, Britcross Limited, supports the fundraising activities of the British Red Cross. The assets, liabilities and trading results of this company, which is incorporated in the UK, are consolidated into the financial statements.The British Red Cross has eight Overseas Branches in British Overseas Territories and these have also been included in the financial statements. Th e British Red Cross is a member of the International Red Cross and Red Crescent Movement, with volunteers and staff contributing to a number of initiatives in both the International Federation of Red Cross and Red Crescent Societies (Federation) and the International Committee of the Red Cross (ICRC). Volunteers carry out a wide range of activities, including responding to emergencies, first aid, delivering health and social care and humanitarian education programmes, supporting refugees and asylum seekers, and fundraising.Without them, we could not carry out this life-saving and lifechanging work. The British Red Cross has more than 320 charity shops across the UK documented management systems, processes and procedures. The system of internal control and risk management is designed to: > The finance and audit committee reviews risk and internal controls and receives regular reports from senior management. > The committee approves the annual risk-based internal audit plan, which cov ers major risks as identified by management and trustees. It receives internal audit reports, regular progress reports and risk updates. Internal audit reports identify areas for improvement in the internal control, risk and governance environment. gt; Senior management reviews key strategic and operational risks on a regular basis. They consider progress on mitigating actions, new and emerging risks, and opportunities. > Management identifies, evaluates and manages risks within their areas from planning to delivery of service. Progress is reported quarterly via Risk management Achievement of the charity’s aims and objectives entails taking risks. The system of internal control is designed to manage risk to a reasonable degree rather than to eliminate all risk of failure relating to achieving aims and objectives. The trustees are responsible for ensuring the charity has effective risk management and internal control systems in place.The board reviews significant risks and ens ures reasonable measures have been taken to manage risks. Senior management has responsibility for managing resources, monitoring performance, and establishing and maintaining effective internal control systems. This is supported by clearly > identify and prioritise the strategic and operational risks to the achievement of the charity’s aims and objectives; > evaluate the likelihood of those risks being realised and their potential impact; and > manage these risks efficiently, effectively and economically. The trustees are satisfied that appropriate internal control systems and risk management processes are in place.They consider that the following framework provides the charity with adequate measures to reduce the impact of identified risks: 16 British Red Cross Trustees’ report and accounts 2011 17 Independent auditors’ report to the trustees of British Red Cross divisional and departmental updates. This is analysed and reported to senior management on a regul ar basis. > Board sub-committees and management groups help identify, evaluate and manage risks relating to fundraising, investments, business continuity, health and safety, remuneration, major infrastructure and IT projects, and operational needs including health and social care, emergency response and the Olympics.Work in this area is continuing with an improvement plan to further enhance the effectiveness of risk management activities and ensure consistency in its application across the charity. The most significant risks to the charity include the impact of government policy including the spending review, fundraising, reputation, security and safety of staff and volunteers, safety of beneficiaries, workforce capacity and capability, management information, IT infrastructure and the challenges of operating major relief programmes. > prepared the accounts on a going concern basis. Financial statements are published on the organisation’s website (redcross. org. k) in accorda nce with legislation in the United Kingdom governing the preparation and dissemination of financial statements, which may vary from legislation in other jurisdictions. The trustees’ responsibilities also extend to the ongoing integrity of the financial statements contained therein. Trustees participated in a range of development activities during the year. From visits to British Red Cross areas, services and events, to external conferences, the British Red Cross ensures its board members are kept abreast of developments in the sector, as well as given the opportunity to broaden their skills and experiences to assist them in discharging their duties effectively.Trustees’ responsibilities The trustees prepare consolidated financial statements for each financial year. These give a true and fair view of the state of the British Red Cross and of the annual results. In preparing the financial statements, the trustees have: > selected suitable accounting policies and applied them consistently; > made judgements and estimates that are reasonable and prudent; > followed applicable accounting standards without any material departures; Public benefit The board of trustees has given regard to the legislative and regulatory requirements for disclosing how its charitable objectives (as set out in our Royal Charter) have provided benefit to the public.The board of trustees has complied with the duty set out in Section 4 of the Charities Act 2011, and that set out by the Office of the Scottish Charity Regulator in the Charities and Trustee Investment (Scotland) Act 2005. This report outlines how our achievements during 2011 have benefited the public, either directly or indirectly. On behalf of the trustees We have audited the financial statements of the British Red Cross Society for the year ended 31 December 2011 which comprise the Consolidated Statement of Financial Activities, the Consolidated Balance Sheets, the Consolidated Cash Flow Statement and the relat ed notes. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice).This report is made solely to the charity’s trustees, as a body, in accordance with the Charities Act 2011 and the Charities and Trustee Investment (Scotland) Act 2005. Our audit work has been undertaken so that we might state to the charity’s trustees those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the charity and the charity’s trustees as a body, for our audit work, for this report, or for the opinions we have formed. Those standards require us to comply with the Auditing Practices Board’s (APB’s) Ethical Standards for Auditors.Scope of the audit of the financial statements A description of the scope of an audit of financial statements is provided on the APB’s website at www. frc. org. uk/apb/ scope/private. cfm. Opinion on financial statements In our opinion the financial statements: > give a true and fair view of the state of the group’s and the parent charity’s affairs as at 31 December 2011 and of the group’s incoming resources and application of resources for the year then ended; > have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice; and > have been prepared in accordance with the Charities Act 2011, the Charities and Trustee Investment (Scotland) Act 2005 and regulations 6 and 8 of the Charities Accounts (Scotland) Regulations 2006 (as amended).Matters on which we are required to report by exception We have nothing to report in respect of the following matters where the Charities Act 2011 and the Charities Accounts (Scotland) Regulations 2006 (as amended) requires us to report to you if, in our opinion: > the information given in the Trustees’ Annual Report is inconsistent in any material respect with the financial statements; or James M. T. Cochrane Chairman of the board of trustees 28 March 2012 Respective responsibilities of trustees and auditor As explained more fully in the Trustees’ Responsibilities Statement (set out on page 18), the trustees are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view.We have been appointed as auditor under section 44(1)(c) of the Charities and Trustee Investment (Scotland) Act 2005 and under section 144 of the Charities Act 2011 and report in accordance with regulations made under those Acts. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). 18 British Red Cross Trustees’ report and accounts 2011 19 > proper and sufficien t accounting records have not been kept; or > the parent charitable company’s financial statements are not in agreement with the accounting records or returns; or > we have not received all the information and explanations we require for our audit.BDO LLP Statutory Auditor Epsom United Kingdom Date: 28 March 2012 BDO LLP is eligible to act as an auditor in terms of section 1212 of the Companies Act 2006. BDO LLP is a limited liability partnership registered in England and Wales (with registered number OC305127). Guei, 24, was one of thousands of refugees from conflict in the Ivory Coast who the Red Cross helped with water and other essentials when they reached Liberia 20 British Red Cross Trustees’ report and accounts 2011 21 Accounts for the year ended 31 December 2011 Summary of income and expenditure for the year ended 31 December 2011 Consolidated statement of financial activities for the year ended 31 December 2011 2011 Total ? m 2010 Total ? m Unrestricted Notes ? Incoming resources Incoming resources from generated funds Voluntary income Trading activities Investment income Total incoming resources from generated funds Incoming resources from charitable activities Emergency response and recovery Resilience Health and social care Supporting the Movement Total incoming resources from charitable activities Other incoming resources Miscellaneous income Net gains on disposal of tangible fixed assets Total incoming resources Resources expended Costs of generating funds Voluntary income Trading activities Total resources expended on generating funds Restricted ? m 2 Income ? 213. 8m ca re in co m e E an me d rg re en co c ve y r ? 1 ry es 5. po 5m ns e R es ili en ce ac tiv iti es so ci al 94. 4 26. 5 0. 3 121. 2 37. 1 37. 1 131. 5 26. 5 0. 3 158. 3 119. 9 24. 8 0. 6 145. 3 S M up ov po ? em rt . 9 en ing m t th O e in th ve er st an m d en t Tr ad in g H ea lth 3 3. 3 14. 7 21. 0 0. 4 39. 4 3. 7 0. 8 0. 6 8. 4 13. 5 7. 0 15. 5 21. 6 8. 8 52. 9 9 . 3 15. 3 25. 1 7. 9 57. 6 .5 m Vo lu nt ar y 5m 6m an d 1. ?2 ? 8 . 8 31 ?1 ?2 ?7 m 6. m 0. 6 2. 0 163. 2 50. 6 0. 6 2. 0 213. 8 1. 1 1. 7 205. 7 44. 6 23. 6 68. 2 28. 2 31. 6 39. 7 2. 0 101. 5 2. 6 4 172. 3 (9. 1) (9. 1) 9 14 (0. 3) (0. 9) (1. 6) (11. 9) 7 7 110. 4 98. 5 0. 9 0. 9 41. 7 7. 4 1. 6 7. 0 57. 7 58. 6 (8. 0) (8. 0) 0. 3 (7. 7) 45. 4 37. 7 45. 5 23. 6 69. 1 69. 9 39. 0 41. 3 9. 0 159. 2 2. 6 230. 9 (17. 1) (17. 1) (0. 3) (0. 6) (1. 6) (19. 6) 155. 8 136. 2 40. 3 23. 5 63. 8 46. 36. 3 41. 4 8. 3 132. 8 2. 6 199. 2 6. 5 6. 5 (0. 2) 1. 7 2. 0 10. 0 145. 8 155. 8 Expenditure ? 230. 9m Su ca pp re ? 2 or . 6 tin m g th G e ov M er ov na em nc en e co t st s E an me d rg re en co c ve y r ry es po ns e C in os co t o m fv e o lu nt ar y ac tiv iti es so ci al Costs of charitable activities Emergency response and recovery Resilience Health and social care Supporting the Movement Total resources expended on charitable activities Governance costs Total resources expended Net (ou tgoing) / incoming resources before transfers Transfers between funds Net (outgoing) / incoming resources before recognised gains and losses Losses on urrent asset investments (Losses) / gains on fixed asset investments Actuarial (losses) / gains on defined benefit pension schemes Net movement in funds Total funds – 1 January Total funds – 31 December All the activities relate to continuing operations. R es ili en ce Tr ad in g 5m 6m 9m 9m 3m H ea lth ? 4 1. ?9 an d ?4 ?2 ?6 ?3 m 5. 3. 9. 7 22 British Red Cross Trustees’ report and accounts 2011 23 Consolidated balance sheet as at 31 December 2011 2011 ? m 64. 4 49. 1 113. 5 Current assets Stocks Debtors Investments Cash at bank and in hand 4. 2 30. 9 6. 6 4. 0 45. 7 Current liabilities Creditors: amounts falling due within one year Net current assets Total assets less current liabilities Creditors: amounts falling due in more than one year Provision for liabilities and charges Net assets before pension scheme s urplus Defined benefit pension scheme surplus Net assets 14 7 (20. ) 25. 7 139. 2 (0. 3) (3. 4) 135. 5 0. 7 136. 2 2010 ? m 63. 8 58. 0 121. 8 Consolidated cash flow statement for the year ended 31 December 2011 Notes Net cash (outflow) / inflow from operating activities (see below) Capital expenditure and financial investment 16 2011 ? m (13. 7) 3. 0 (10. 7) Decrease in current asset investments Decrease in cash 17 4. 3 (6. 4) 2010 ? m 8. 4 (19. 4) (11. 0) 9. 7 (1. 3) Notes Fixed assets Tangible fixed assets Investments 8 9 10 9 3. 3 29. 0 11. 2 10. 4 53. 9 Reconciliation of net incoming resources to net cash outflow from operating activities Net (outgoing) / incoming resources Depreciation charge Net gains n disposal of tangible fixed assets Increase in stocks Increase in debtors Increase in creditors Increase / (decrease) in provisions for liabilities and charges Net charges for defined benefit pension scheme Net cash (outflow) / inflow from operating activities Reconciliation of net funds to movement in short-term funds less borrowing Decrease in cash Decrease in current asset investments (6. 4) (4. 3) (10. 7) Losses on current asset investments (0. 3) (11. 0) Net short-term funds less borrowing at 1 January Net short-term funds less borrowing at 31 December 17 21. 3 10. 3 (1. 3) (9. 7) (11. 0) (0. 2) (11. 2) 32. 5 21. 3 (17. 1) 6. 7 (2. 0) (0. 9) (1. 9) 2. 6 0. 1 (1. 2) (13. 7) 6. 5 6. 5 (1. 7) (0. 4) (1. 5) 2. 0 (2. 2) (0. 8) 8. 4 11 (17. 4) 36. 5 158. 3 (0. 3) (3. 3) 154. 7 1. 1 155. 8 12 Funds: Restricted funds Unrestricted funds tangible fixed assets Defined benefit pension scheme fund Free available reserves Unrestricted funds Total funds 7 7 37. 7 56. 0. 7 41. 4 98. 5 136. 2 45. 4 54. 6 1. 1 54. 7 110. 4 155. 8 The accompanying notes form an integral part of these consolidated financial statements. The British Red Cross has not prepared a separate balance sheet for the charity as this is not considered to be materially different to the consolidated balance sheet. For and on behalf of the British Red Cross, James Cochrane Chairman, board of trustees 28 March 2012 David Howell Chairman, finance and audit committee 28 March 2012 24 British Red Cross Trustees’ report and accounts 2011 25 Notes to the consolidated financial statements for the year ended 31 December 2011 1. Accounting policies a) Scope and basis of the financial statements The consolidated financial statements have been prepared under the historical cost convention, as modified by the revaluation of investments at market value, and are in accordance with Accounting and Reporting by Charities: Statement of Recommended Practice (Revised 2005) (‘the SORP’), applicable accounting standards in the United Kingdom and the reporting requirements of the Charities Act 2011. The results and balance sheet of the British Red Cross’ subsidiary, Britcross Limited, have been consolidated on a line by line basis. Britcross Limited makes up accounts to 31 D ecember. Separate statements of financial activities and balance sheet have not been presented for the charity alone as these are not considered to be materially different from the consolidated statement of financial activities and consolidated balance sheet.The financial statements incorporate the results of all material activities overseas where the British Red Cross has operational responsibility. The results and net assets of Red Cross operations in eight British Overseas Branches have been included in the financial statements. (b) Fund accounting General unrestricted funds are available for use at the discretion of the trustees in furtherance of the general charitable objectives. A pension reserve is included within unrestricted funds to reflect the pension surplus. Restricted funds are donated for either a particular area or purpose, the use of which is restricted to that area or purpose. Such donations are principally for international purposes. c) Incoming resources All inco me is accounted for when the British Red Cross has entitlement to the funds, the amount can be quantified and there is certainty of receipt. Where income is received in advance of providing goods and/or services, it is deferred until the British Red Cross becomes entitled to that income. Unless there is evidence of uncertainty of receipt, residuary legacies are recognised from the date of probate where a reliable estimate of income can be made. Income from will or reversionary trusts is not recognised until the life interest has passed away. Income from pecuniary legacies is recognised upon notification. Disasters Emergency Committee (DEC) appeal income is recognised to the extent that resources have been committed on programmes funded through the DEC appeals.Gifts donated for resale are included as income when they are sold. Donated assets and services are included at the value to the British Red Cross where this can be reliably quantified. Donated services from our volunteers are not included within the financial statements. (d) Resources expended and basis of allocation of cost All expenditure is accounted for on an accruals basis. Direct costs are those specifically related to producing the output of an activity, for example the costs incurred in direct contact with beneficiaries. Support costs are those which provide indirect support to front-line output provision – examples are central finance, human resources and management information services.Support costs not attributable to a single activity have been allocated on a basis consistent with identified cost drivers for that cost category such as staff head count, floor space and expenditure. Governance costs relate to the direct running of the charity, allowing the charity to operate and generate the information required for public accountability. They include the costs of subscriptions related to membership of the International Red Cross and Red Crescent Movement, as well as the costs of trustee meetings and internal and external audits. (e) Tangible fixed assets and depreciation All tangible fixed assets costing more than ? 1,000 are capitalised and included at cost, including any incidental expenses of acquisition and irrecoverable VAT.Depreciation is provided on a straight-line basis over their useful economic lives as follows: Freehold properties Leasehold properties > Shop premises > Other premises Freehold premises improvements Leasehold premises improvements Ambulances Other vehicles Equipment and furniture Computer equipment and software Freehold land Assets in course of construction 50 years the shorter of the term of the lease and five years the shorter of the term of the lease and 50 years ten years the shorter of the term of the lease and ten years seven years five years five years between one and three years nil nil (f) Pensions The defined benefit pension scheme current service costs, together with the scheme interest cost less the expected return on the sche me assets for the year, are charged to the relevant expenditure heading within the consolidated statement of financial activities in line with the salary costs of the related employees. The defined benefit scheme assets are measured at fair value at the balance sheet date.Scheme liabilities are measured on an actuarial basis at the balance sheet date using the projected unit method and discounted at a rate equivalent to the current rate of return on a high-quality corporate bond of equivalent term to the scheme liabilities. The change in value of assets and liabilities arising from asset valuation, changes in benefits, actuarial assumptions, or change in the level of deficit attributable to members is recognised in the consolidated statement of financial activities within actuarial gains/losses on defined benefit pension schemes. The resulting defined benefit asset or liability is presented separately on the face of the balance sheet.The British Red Cross recognises assets for its d efined benefit pension schemes to the extent that they are considered recoverable with reference to expected future current service costs for active scheme members. Pension costs in respect of defined contribution schemes are charged to the consolidated statement of financial activities for the period in which they are payable. (g) Investments Investments are stated at market value at the balance sheet date and the consolidated statement of financial activities shows net investment gains and losses arising from revaluation of the investment portfolio and disposals during the year. (h) Stocks Stocks are stated at the lower of cost and net realisable value. Provision is made for obsolete, slow-moving or defective stock where appropriate.Items donated for resale and distribution are not included in the financial statements until they are sold or distributed. Emergency stocks held for disaster response are transferred from stock to resources expended when issued from the warehouse. (i) Value added tax Irrecoverable value added tax is allocated to the category of expenditure to which it relates. (j) Provisions Provisions are recognised when the British Red Cross has a legal or constructive financial obligation, that can be reliably estimated and for which there is an expectation that payment will be made. (k) Operating leases Rentals under operating leases are charged on a straightline basis over the lease terms, even if the payments are not made on such a basis.Benefits received and receivable as an incentive to sign an operating lease are, similarly, spread on a straight-line basis over the lease term, except where the period to the review date on which the rent is first expected to be adjusted to the prevailing market rate is shorter than the full lease term, in which case the shorter period is used. (l) Foreign currencies The British Red Cross uses forward exchange contracts to hedge some of its known foreign exchange exposure. Transactions in foreign currencie s are recorded at the rate of exchange prevailing at the date of the transaction, except where a forward contract is in place, in which case the rate specified in the contract is used.Monetary assets and liabilities are translated into sterling at the exchange rate ruling on the balance sheet date, except where a forward contract is in place, in which case the relevant asset/liability is translated at the rate contained in the contract. Foreign exchange gains are recognised as other income and foreign exchange losses are recognised in the consolidated statement of financial activities within the relevant charitable activity expenditure for the period in which they are incurred. 26 British Red Cross Trustees’ report and accounts 2011 27 Notes to the consolidated financial statements for the year ended 31 December 2011 2. Voluntary income Unrestricted ? Regular giving Public donations, appeals and fundraising Service donations Gift aid Legacies Disasters Emergency Committee app eals Grants Total 41. 9 19. 0 2. 4 12. 3 18. 8 94. 4 Restricted ? m 26. 0 0. 1 1. 8 0. 9 8. 3 37. 1 2011 Unrestricted Total ? m 41. 9 45. 0 2. 5 14. 1 19. 7 8. 3 131. 5 34. 6 17. 6 2. 4 10. 5 21. 5 86. 6 Restricted ? m 20. 7 0. 1 1. 8 0. 6 8. 4 1. 7 33. 3 2010 Total 34. 6 38. 3 2. 5 12. 3 22. 1 8. 4 1. 7 119. 9 Costs of generating funds Voluntary income Trading activities 44. 3 22. 9 67. 2 Charitable activities Emergency response and recovery UK International 23. 1 44. 6 67. 7 Resilience UK International 25. 8 10. 8 36. 6 2011 Total ? m 3. 9 3. 1 7. 0 14. 9 0. 6 15. 5 6. 9 14. 7 21. 6 8. 8 52. 9 2010 Total ? m 3. 0 6. 3 9. 3 Governance costs 0. 2 0. 0. 8 Health and social care Medical equipment services Care and support programmes 0. 3 3. 5 3. 8 Supporting the Movement Total 7. 2 15. 7 14. 7 14. 7 6. 6 11. 2 17. 8 1. 6 37. 2 0. 6 0. 5 1. 1 0. 3 3. 3 3. 6 6. 2 17. 2 14. 0 0. 2 14. 2 10. 7 10. 8 21. 5 1. 7 40. 4 14. 6 0. 7 15. 3 11. 0 14. 1 25. 1 7. 9 57. 6 Total 220. 6 10. 3 230. 9 1 99. 2 Subscriptions to Federation Staff Fees to auditors for audit of financial statements Fees to auditors for other services Other 1. 9 0. 3 0. 1 0. 2 2. 5 0. 1 0. 1 1. 9 0. 3 0. 1 0. 3 2. 6 1. 6 0. 6 0. 1 0. 3 2. 6 Health and social care Medical equipment services Care and support programmes 11. 8 25. 9 37. Supporting the Movement 8. 9 150. 9 0. 9 2. 7 3. 6 0. 1 8. 3 12. 7 28. 6 41. 3 9. 0 159. 2 16. 2 25. 2 41. 4 8. 3 132. 8 2. 1 0. 3 2. 4 27. 9 11. 1 39. 0 25. 2 11. 1 36. 3 1. 4 0. 8 2. 2 24. 5 45. 4 69. 9 20. 7 26. 1 46. 8 1. 2 0. 7 1. 9 45. 5 23. 6 69. 1 40. 3 23. 5 63. 8 4. Resources expended Direct costs ? m Support costs ? m 2011 Total ? m 2010 Total ? m Legacy income is not recognised until the British Red Cross has entitlement to the funds, the amount can be quantified and there is certainty of receipt. The estimated value of legacies, which have been notified but not recognised at 31 December 2011, was ? 7. 4 million (2010: ? 9. 2 million) of which ? . 4 million (2010: ? 6. 6 million) are assets bequeathed to the British Red Cross, but subject to life tenancy. Disasters Emergency Committee (DEC) appeal income is recognised to the extent that resources have been committed on programmes funded through the DEC appeals. Subject to our agreed allocation, the value of DEC appeal income not drawn down or accrued for at 31 December 2011 was ? 2. 6 million (2010: ? 5. 5million). 3. Incoming resources from charitable activities Grants ? m Emergency response and recovery UK International 0. 8 3. 1 3. 9 Resilience UK International Other ? m 3. 1 3. 1 Grants ? m 0. 2 6. 1 6. 3 Other ? m 2. 8 0. 2 3. 0 Supporting the Movement’ grant income is mainly from the Department for International Development (DFID). ?1. 2 million (2010: ? 1. 1 million) was received as part of our Partnership Programme Agreement (replacing the Strategic Framework Agreement), which provides core funding for our international work to strengthen further the effectiveness of the Intern ational Red Cross and Red Crescent Movement as a key pillar of the international humanitarian system. ?6. 0 million (2010: ? 5. 1 million) was received as part of our Institutional Strategy agreement with the International Federation of Red Cross and Red Crescent Societies (IFRC), which provides funding for their programmes and operations.The charity v has supported our youth volunteering, Future Jobs Fund and National Citizen Service activities. The income for 2011 is ? 187,000 (2010: ? 90,000). The basis of allocation of support costs is described in note 1(d) and further analysis is provided in note 5. Our total resources expended includes irrecoverable VAT of ? 2. 9m (2010: ? 2. 1m). Included under 2011 direct costs are grants to the International Federation of Red Cross and Red Crescent Societies (IFRC) and International Committee of the Red Cross (ICRC) of ? 20. 1 million (2010: ? 19. 5 million) and grants to other National Societies of ? 22. 2 million (2010: ? 6. 6 million). 28 British Red Cross Trustees’ report and accounts 2011 29Notes to the consolidated financial statements for the year ended 31 December 2011 5. Support costs by activity Cost of generating funds Emergency response Supporting and Health and the recovery Resilience social care Movement Governance 2011 Total 2010 Total 7. Funds Balance 1 January 2011 Net investment gain / Expenditure (losses) Actuarial losses on defined benefit pension Balance 31 December Transfers 2011 ?m ?m ?m ?m ?m ?m ?m 2. 6 3. 7 3. 6 0. 4 ?m 2. 4 3. 6 Total UK restricted funds Total unrestricted funds ?m Income ?m ?m ?m ?m ?m ?m Finance Human resources and central facilities Management information services Central management Total 0. 8 0. 6 0. 4 0. 1 1. 9 0. 9 0. 6 0. 6 0. 1 2. 0. 5 0. 9 0. 9 0. 1 2. 4 0. 4 1. 6 1. 5 0. 1 3. 6 0. 1 0. 1 0. 1 0. 1 110. 4 163. 2 (172. 3) (1. 2) (1. 6) – 98. 5 17. 1 9. 0 13. 3 22. 3 6. 0 45. 4 155. 8 3. 8 4. 9 14. 4 26. 9 46. 2 0. 6 50. 6 213. 8 (6. 8) (7. 2) (14. 2) (2 7. 4) (48. 8) (3. 0) (58. 6) (230. 9) 0. 1 0. 2 0. 2 0. 3 (0. 9) (1. 6) (0. 5) (0. 5) 0. 5 – 14. 2 6. 7 0. 2 12. 5 19. 4 4. 1 37. 7 136. 2 3. 4 0. 4 9. 8 Haiti earthquake Japan Other international restricted funds Total international restricted funds Disaster Fund Total restricted funds Total funds 10. 3 Support costs have been allocated on the basis of the accounting policy set out in note 1 (d). 6. Trading subsidiaryBritcross Limited, the British Red Cross’ wholly owned trading subsidiary incorporated in the United Kingdom, engages in the sale of cards and gifts as well as corporate sponsorship in aid of the British Red Cross. The turnover and expenditure included within trading activities are: 2011 ? m Turnover Expenditure Net income donated to British Red Cross The assets and liabilities of Britcross Limited consolidated within the balance sheet are: Current assets Current liabilities Net assets 1. 4 (0. 9) 0. 5 2011 ? m 0. 8 (0. 8) 2010 ? m 1. 4 (0. 9) 0. 5 2010 ? m 0. 7 (0. 7) – Restricted funds Expenditure plans have been agreed for all material restricted funds. Funds are held in appropriate asset categories in accordance with planned usage. UK restricted funds UK restricted funds include: > ? million of properties and other tangible fixed assets held for restricted purposes > a variety of local, national and European funding sources to deliver projects over the next 2-3 years > legacies with a geographical and/or service restriction. The balance of UK restricted funds is held for the provision of locally agreed services. International restricted funds Significant programmes of work are planned for the disbursement of international restricted fund balances as at 31 December 2011. Other international restricted funds include: > ? 2. 4 million of stock for international programmes > ? 1. 5 million represented by net assets of the Overseas Branches. Disaster Fund The Disaster Fund allows us to prepare for and respond to humanitarian d isasters abroad and in the UK.We fundraise specifically for the Disaster Fund and, as stated on emergency appeal materials, it can also contain funds donated to emergency appeals where we raise more than can be reasonably and efficiently spent on that specific response. 30 British Red Cross Trustees’ report and accounts 2011 31 Notes to the consolidated financial statements for the year ended 31 December 2011 8. Tangible fixed assets Freehold property ? m 45. 9 0. 1 2. 5 (0. 5) 48. 0 Vehicles, Assets in the Leasehold equipment course of property and furniture construction ? m ? m ? m 34. 2 0. 1 (0. 5) 33. 8 41. 2 0. 3 3. 5 (1. 1) 43. 9 0. 6 (0. 5) 2. 0 2. 1 Total ? m 121. 9 8. 0 (2. 1) 127. 8 9. InvestmentsFixed assets investments Market value – 1 January 2011 Additions at cost Disposals at market value Net investment losses in the year Market value – 31 December 2011 Cost – 31 December 2011 Total ? m 58. 0 3. 0 (11. 3) (0. 6) 49. 1 47. 1 Cost At 1 Januar y 2011 Completions Additions Disposals At 31 December 2011 Accumulated depreciation At 1 January 2011 Charge Disposals At 31 December 2011 Net book value At 31 December 2011 At 31 December 2010 13. 1 1. 8 (0. 2) 14. 7 11. 6 1. 1 (0. 2) 12. 5 33. 4 3. 8 (1. 0) 36. 2 – 58. 1 6. 7 (1. 4) 63. 4 The portfolio consists of the following: UK equities Overseas equities UK fixed income Market value 2011 ? m 7. 8 5. 9 35. 4 49. 1 Per cent of Market value 2011 2010 portfolio ? m 16% 12% 72% 86. 0 6. 3 43. 1 58. 0 Per cent of 2010 portfolio 15% 11% 74% 33. 3 32. 8 21. 3 22. 6 7. 7 7. 8 . 1 0. 6 64. 4 63. 8 The following investments represented more than 5 per cent of the value of the portfolio at 31 December 2011 Lazard Thematic Global Institutional Share Class Legal & General CAF UK Equitrack Black Rock Ultra Short Bond Fund Number of units 67,350 12,988,700 287,196 Market value ? m 5. 9 7. 5 35. 4 Per cent of portfolio 12% 15% 72% Current asset investments Royal Bank of Scotland Global Treasury Funds plc BlackRock – Institutional Sterling Liquidity Fund 2011 ? m 6. 2 6. 2 2010 ? m 4. 1 1. 0 5. 1 5. 4 0. 7 11. 2 Deposits Investment property in the UK Total 0. 4 6. 6 32 British Red Cross Trustees’ report and accounts 2011 33Notes to the consolidated financial statements for the year ended 31 December 2011 10. Debtors 2011 ? m Trade debtors Accrued income Other debtors Prepayments Tax recoverable Legacies receivable Total 4. 6 6. 9 1. 0 3. 5 4. 4 10. 5 30. 9 2010 ? m 6. 5 4. 7 0. 4 3. 3 4. 0 10. 1 29. 0 At 31 December 2011 Amounts expected to be incurred: – within one year – beyond one year 1. 1 1. 1 1. 3 1. 0 2. 3 2. 4 1. 0 3. 4 1. 1 2. 3 3. 4 At 1 January 2011 Payments during the year Increase in provision 12. Provisions for liabilities and charges Rehabilitation Leasehold commitments dilapidations ? m ? m 1. 2 (1. 2) 1. 1 2. 1 (1. 5) 1. 7 Total ? m 3. 3 (2. 7) 2. 8 All amounts shown under debtors fall due for payment within one year. 11 .Creditors: amounts falling due within one year 2011 ? m Trade creditors Accruals Other creditors Deferred income Taxes and social security costs Total 3. 3 12. 0 1. 2 1. 9 1. 6 20. 0 2010 ? m 2. 1 10. 9 1. 1 2. 0 1. 3 17. 4 The provision for rehabilitation commitments as at 31 December 2011 includes amounts committed in Haiti for livelihood grants. Leasehold dilapidations relate to properties where the British Red Cross has a legal responsibility as tenant for such costs. 13. Staff emoluments and trustee expenses Total staff emoluments (including casual staff) for the year were as follows: Salary costs National insurance costs Pensions costs 2011 ? m 68. 7 5. 1. 0 75. 6 2010 ? m 63. 0 5. 4 1. 2 69. 6 Movements in deferred income during the year were as follows: At 1 January Income recognised during the year Income deferred during the year At 31 December 2011 ? m 2. 0 (2. 0) 1. 9 1. 9 2010 ? m 2. 6 (2. 6) 2. 0 2. 0 The number of employees whose emoluments, as defined for taxation pu rposes (basic pay, vehicle and medical insurance benefits), amounted to over ? 60,000 in the year were as follows: ? 60,001 – ? 70,000 ? 70,001 – ? 80,000 ? 80,001 – ? 90,000 ? 90,001 – ? 100,000 ? 100,001 – ? 110,000 ? 110,001 – ? 120,000 ? 170,001 – ? 180,000 ? 180,001 – ? 190,000 2011 6 6 3 5 1 2 1 2010 8 6 5 2 1 1 1 –Five (2010: five) of the above employees have retirement benefits accruing to them under defined benefit pension schemes. The total cost of the contributions to these defined benefit schemes made by the British Red Cross for these employees was ? 106,000 (2010: ? 94,000). Thirteen (2010: fourteen) of the above employees are members of a defined contribution scheme. The total cost of the contributions to this scheme made by the British Red Cross for these employees was ? 81,000 (2010: ? 61,000). 34 British Red Cross Trustees’ report and accounts 2011 35 Notes to the consolidated financial statement s for the year ended 31 December 2011 13. Staff emoluments and trustee expenses (continued)The average number of full-time equivalent staff employed by the British Red Cross during the year was as follows: In the UK Fundraising Retail UK services First aid services International services Other Overseas International services Total employed by FTE Total employed by headcount The average number of volunteers working for the British Red Cross during the year was as follows: In the UK Fundraising Retail UK services First aid services International services Total Trustees’ expenses: Expenses incurred by trustees and reimbursed by the British Red Cross Expenses incurred by the British Red Cross on behalf of trustees Trustees’ indemnity insurance cover cost 2011 171 547 1,475 405 72 280 65 3,015 3,547 2010 147 544 1,417 379 66 249 54 2,856 3,364 14. PensionsNew British Red Cross staff are entitled to join either the Pensions Trust’s Unitised Ethical Plan or the Pension s Trust’s Flexible Retirement Plan. Staff had previously been entitled to join the British Red Cross Pension Fund (â€Å"UK Office scheme†), Scottish Branch British Red Cross Society Retirement Benefits Scheme (â€Å"Scottish scheme†) or the Pensions Trust’s Growth Plan. These three schemes are all closed to new entrants. UK Office and Scottish defined benefit pension schemes The assets of these pension schemes are held in separate trustee-administered funds. The schemes are subject to triennial valuations with the last full valuation being carried out as at 31 December 2010 for the UK Office scheme and 1 January 2009 for the Scottish scheme.These valuations were updated at 31 December 2010 and 2011 by independent actuaries on a Financial Reporting Standard 17 – Retirement Benefits (FRS 17) b

Evidence Based Practice in Mental Health Nursing Essay

One of the most common and disabling psychological disorders encountered within mental health and general medical settings is that of an anxiety disorder (Dattilio & Kendall 2000). Research has indicated that people with learning disabilities are more prevalent to psychological disorders than the general population (Hassiotis et al 2000) consequently it could be hypothesised that prevalence rates of anxiety disorders are similar if not greater within the learning disabled population. Professional literature suggests that cognitive-behaviour therapy (CBT) has been an effective treatment against anxiety disorder (Beck 1995) however; this literature has predominately concentrated its focus to within the confines of mental health and general medical settings (Dattilio & Kendall 2000). The ability of people with learning disabilities to identify, evaluate and respond to their dysfunctional thoughts and beliefs, fundamentals of CBT (Beck 1995) have put into question the very use of this treatment programme for this particular client group (Kroese et al 1997). From a professional and personal perspective and through the utilisation of the Seedhouse (1998) ‘Ethical Grid’ responding to an anxiety disorder by way of CBT could be considered an ethically acceptable clinical intervention. Nationally and locally through government directives, ‘Valuing People’ (Department of Health 2001) and initiatives such as Health Action Plans (Department of Health 2002) services have recognised that they need to be more responsive to the mental health needs of people with learning disabilities. As a learning disability nurse wishing to ascertain the effectiveness of CBT as a practical intervention when presented with the dual-diagnosis of anxiety disorder and l earning disability, is through the use of ‘evidence-based practice’. When deciding on the best possible clinical intervention for an identified practice problem it seams logical to convert the issue into a single answerable question (Colyer & Kamath 1999). Several authors have identified that the use of frameworks to inform the development of the clinical question provide the practitioner with a systematic process of formulating an answerable question (Sackett et al 1997 Ridsdale1998). One such framework as described by Sackett et al (1997) is a four- stage process, known by the acronym PICO: Patient or Population Intervention or Indicator Comparison or Control Outcome The construction of an answerable question is the basis of evidence-based practice and should guide the practitioner to how to find an answer (Ridsdale 1998). It is important that each variable under the PICO framework is clearly defined, being as detailed and explicit as possible in order to extend clarification to the question. Working through PICO methodically the practitioner would instigate the process by defining the ‘Patient or Population’. Characteristics such age, gender and diagnosis would need to be deliberated and whilst the aforementioned were easily recognised in the practice area as adult male, identifying appropriate terminology for diagnosis can prove problematic. The term ‘Learning Disability’ is often used interchangeably in literature with terms such as, Mental Retardation and Intellectual Disabilities. ‘Learning Disability’ is a term with contemporary usage within the United Kingdom to describe a client group with significant development delays (Gates 1996). Whilst the idiom ‘Learning Disability’ is the preferred terminology for the question due to its contemporary usage it must be accepted that it’s a term not internationally recognised nor is it a term used for long in the United Kingdom (Gates 1996). Anxiety disorder comes in many facets and can be described as severe psychological disorders in which abnormal or chronic anxiety interferes with daily living (Adams & Bromley 1998). The client in the practice area had described psychological and physiological symptoms that were diagnosed as a social anxiety disorder through rating scales and self-report measures. It is crucial that the practitioner is aware that the term identified for the question as ‘social anxiety’ is often recognised by the synonyms, social phobia or panic disorder (Dattilio & Kendall 2000). The recognition of this inconsistent terminology will enable an evaluation to  take place between the relationships of the chosen term to symptoms displayed by the client. The identification of existing clinical interventions is a valuable part of the process of developing evidenced-based interventions (Meijel 2003). Literature suggests that CBT is an effective treatment for a number of psychological disorders (Embling 2002 Hatton 2002). Central to the model of CBT is that distorted or dysfunctional thinking is prevalent in all psychological disorders (Beck 1995). Analysis of accumulated experience of existing interventions and the aforementioned evidence of its validity led to the application of CBT as the ‘question intervention’. It is not imperative for the question to have a comparison intervention and this was the situation in the clinical problem described, therefore the conclusive element utilising the PICO framework was ‘outcome’. The outcome should be measurable (Sackett et al 1997) and after initially trivialising with the term ‘used’ it became evident that this would not develop into something that could be measured. Discussing whether or not an intervention is ‘effective’ however would provide the question with a measurable outcome. Revision of the terminology identified through the PICO framework would consequently translate the question as – Is cognitive-behaviour therapy an effective intervention for adult males with learning disabilities diagnosed as suffering from social anxiety? A well-formulated search strategy is an essential component in gathering appropriate evidence (Hewitt-Taylor 2002). Ridsdale (1998) discusses a four-stage search strategy that helps to translate the question into a meaningful search – a) Identify the subject elements of the question b) Define the relationship between the subject elements c) Convert the subject elements into search themes d) Decide on the scope of the search Assistance to define the subject elements can be found within the PICO framework – Patient – Learning Disability, Social Anxiety Intervention – CBT Outcome – Effectiveness Once identified an effective means of linking the subject elements of a question for the search process is through the use of ‘operators’. Operators such as: And – Or – Not, form a logical link between the elements of the question and can be used collectively or individually in any electronic database search (Ridsdale 1998). All of the subject elements of the question were required in order provide a conclusive answer therefore the operator required for the search strategy could be identified as ‘And’. The subject elements then require conversion into terms by which references can be retrieved (Ridsdale 1998). A keyword search would apply the terms identified as the subject elements, however making a list of the known synonyms of the subject elements such as Intellectual Disability and Mental Retardation, for inclusion, would substantially develop the search process. Finally the scope of the search decides what is wanted from the search. In order to identify the most appropriate type of evidence that is required for the practice problem the type of question asked must be identified (Sackett et al 1997). The question developed through the PICO framework can be readily identified as questioning, ‘the effectiveness of a therapy’. Sackett et al (1997) proposes that the best available evidence to answer this type of question is comparative / prospective studies and ideally random controlled trials (RCTs) which in turn determine the choice of database (Ridsdale 1998). Sackett et al (1997) provides a comprehensive catalogue of information resources such as databases, journals and web sites along with descriptions  of the type of evidence that can be found within these resources. It was established previously that the best type of evidence for the question would be RCTs and comparative / prospective studies. From the descriptions supplied by Sackett et al (1997) it could be identified that the Cochrane Library supplies the user with full text systematic reviews of effects of health-care interventions along with bibliographies of controlled trials. Further electronic databases identified through Salford University library information services were PsycINFO that contains citations and summaries of journal articles and books in the field of psychology chosen for its congruity with the clinical intervention. ‘Swetswise’ an electronic journal aggregator that provides access to full text publications from several major health care related academic publishers and ‘IngentaConnect’ which offers full text availability for all core Blackwell science and medical journals were chosen due to familiarity of use and extensive subject matter. Other databases considered were CINAHL, EMBASE and AMED however all were discounted due to their general nursing bias. Despite the recognition of Ridsdale’s (1998) four-stage search strategy and its systematic approach the initial search were completed exploiting familiar strategies through the IngentaConnect database. Preconceptions from previous endeavours searching for relevant evidence furnished the belief that a similar strategy would provide sufficient evidence to answer the question. A number of the subject elements were used through keyword searches whilst the operator ‘And’ was used to link each in turn (See Appendix). This easy to use search strategy produced a number of hits however none matched the criteria identified as being the most appropriate type of evidence to answer the question. The search revealed that almost all of the evidence found belonged in either mental health (Heimberg 2002) or general medical settings (Scholing & Emmelkamp 1999). Whenever the term learning disability or mental retardation was utilised they invariable appeared indiscriminately amidst the title or abstract of the article providing no specific relevance to the question. The frustration born out of this strategy led to further searches of electronic databases firstly through another familiar database, Swetswise. Ridsdale (1998) identifies that too many hits will be recovered if the subject element is to general  and this was evident in the first keyword search. The term learning disabilities produced 548 hits (See Appendix) far too many to feasibly scan. The subsequent four searches failed to produce a single hit a possibility also recognised by Ridsdale (1998) who suggests alternative synonyms are utilised in this circumstance. Due to the inability to find any relevant material of value towards answering the question Ridsdale’s (1998) four-stage strategy was then conscientiously adopted in conjunction with the knowledge acquired through lectures received at Salford University. A further search of Swetswise database was completed (See Appendix) which revealed significantly less hits than previously achieved but produced a literature review (Hatton 2002) specifically aimed at the use of CBT and people with learning disabilities. Whilst this evidence did not fulfil previous identified criteria it established that pursuing Ridsdale’s (1998) strategy could provide some success. A similar approach was undertaken while searching the Cochrane Library database which allows the user to restrict the search to the acquisition of systematic reviews and controlled trials whilst using a simple keyword option. Again the subject elements were utilised along with the recognised operator and despite new found co nfidence and knowledge the search strategy revealed no evidence of systematic reviews or RCTs with regards to the question (See Appendix). All systematic reviews or RCTs retrieved belonged within general and mental health settings. The final electronic database to be utilised was PsycINFO (via Ovid) where again Ridsdale’s (1998) four-stage strategy was conscientiously adopted. PsycINFO requires the user to have some prior knowledge of how to use electronic databases and their search strategies, which initially can prove bewildering to the novice. Once familiar with the database and its ability to combine search strategies either through keyword, journal or author the user should find it a practical resource (See Appendix). No systematic reviews or RCTs were found within the results however a further literature review (Feldman & Rivas-Vazquez 2003) aimed at psychosocial interventions and people with intellectual disabilities was unearthed along with evidence from child and adolescence services (Dadds & Spence 1997) and psychiatric services (Carmin & Albano 2003). Hatton (2002) suggests that research evidence on the effects of psychosocial interventions  for people with learning disabilities is sparse, whilst Kroese (1998) adds that therapists are reluctant to engage into therapy with this client group due to their dislike of having to relate to them. In an attempt to discover any type of evidence relating to people with learning disabilities and CBT the Salford University library catalogue was searched (See Appendix). A simple keyword search revealed one book (Kroese et al 1997) attaining the subject elements however again it did not produce the type of evidence recognised as the most appropriate to answer the question. Sackett et al (1997 p.2) defines evidence based practice as: â€Å"†¦the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients†. With this definition in mind it should be established as to what constitutes ‘current best evidence’ and its implications for the practitioner wishing to implement ‘evidence based practice’. Belsey & Snell (2001 p.2) states that, â€Å"†¦evidence is presented in many forms†¦ and the value of evidence can be ranked according to the following classification in descending order of credibility†: I. Strong evidence from at least one systematic review of multiple well-designed randomised controlled trials II. Strong evidence from at least one properly designed randomised controlled trial of appropriate size III. Evidence from well-designed trials such as non-randomised trials, cohort studies, time series or matched case-controlled studies IV. Evidence from well-designed non-experimental studies from more than one centre or research group V. Opinions of respected authorities, based on clinical evidence, descriptive studies or reports of expert committees In accepting this hierarchy of evidence practitioners should concede that the systematic review of multiple well-designed RCTs constitutes ‘best available evidence’ (Colyer & Kamath 1999). Sullivan (1998) adds weight to this argument when he states that RCTs constitute the strongest source of evidence and that the scientific community prefer the quantitative research technique that makes use of empirical data following a systematic process. Whilst a number of RCTs were found (Dadds & Spence 1997 Scholing & Emmelkamp 1999) whilst undertaking the search strategy none belonged within learning disability settings. The only evidence found specific to the original question were literature reviews and a specialist book (Kroese et al 1997) aimed at CBT and learning disabilities. The literature reviews (Hatton 2002 Kroese 1998) revealed that a number of case studies and a case series had demonstrated the potential feasibility of CBT reducing anxiety amongst people with learning disabilities. Whilst the specialist book (Kroese et al 1997) discussed conceptual and contextual issues of CBT and people with learning disabilities suffering anxiety disorders. This type of evidence appears in the lower reaches of the hierarchy of evidence and as such its subjectivity, reliability and validity can be disputed (Sullivan 1998). Whilst acknowledging the hierarchy of evidence and the proposal that comparative / prospective studies and ideally RCTs were the best forms of evidence to answer this type of question (Sackett et al 1997) it appears that in their absence the evidence revealed is the ‘best available’. RCTs are widely acknowledged as the gold standard of evidence-based practice (Rowland & Goss 2000) however it is suggested that they bear little resemblance to day-to-day reality (McInnes et al 2001). RCTs can be pragmatic or explanatory the former is concerned with the overall effectiveness of an intervention whilst the latter examines the impact of specific treatment elements on outcome (Parry 2000) however neither considers the perspectives and uniqueness of the respondents. The evidence recovered for the question (Hatton 2002 Kroese 1998) albeit in the lower reaches of the hierarchy acknowledges the feelings of the respondents due to its qualitative nature (patient centred, holistic and humanistic) therefore making it extremely suitable for the study of nursing phenomena (Parahoo  1997) along with its relevance as regards answering a therapy question (Parry 2000). Kroese (1997) offers a number of reasons why there is this lack of quantitative research evidence surrounding the subject elements in the question. He suggests that people with a learning disability are a devalued population, it is impossible to ensure that changes are due to clinical manipulations if individuals (learning disabled) do not have stable cognitions. Finally there is a conjecture that anxiety in people with learning disabilities is the same as in the general population consequently there is no need for specifically focused research. It emerges that learning disability services continue to adapt research evidence from general and mental health settings (Finlay & Lyons 2001) a similar approach with the RCTs recovered from the search strategy could make them a valued resource however it would take a skilled clinician to make this a feasible option. Reflection is a necessary component of Continuing Professional Development and is a legitimate method for questioning personal effectiveness and responsibility in all aspects of health care (Driscoll & Teh 2001). Through the process of reflection the practitioner recognised his own limitations in identifying appropriate evidence for his clinical problems, along with the often inconclusive, time consuming and frustrating strategies undertaken in the search of evidence in support of his clinical practice. The structured frameworks utilised throughout the process described earlier gave the practitioner a systematic approach to formulating a question, developing a search strategy and identifying appropriate evidence to answer his practice problem. The ability to systematically approach future clinical problems will enable the practitioner to offer his clients a holistic, client centred practice from the best external evidence available. Adams, B. Bromley, B. (1998) Psychology for Health Care Key Terms and Concepts, London, Macmillan Press Beck, J.S. (1995) Cognitive Therapy Basics and Beyond, London, Guildford Press. Belsey, J. Snell, T. (2001) What is Evidence-Based Medicine? [Internet] Available from www.jr2.ox.uk/bandolier (Accessed 7th December 2004) Carmin, C.N. Albano, A.M. (2003) Clinical Management of Anxiety Disorder in Psychiatric Settings: Psychology’s Impact on Evidence-Based Treatment of Children and Adults, Professional Psychology: Research and Practice, Vol. 34, No. 2 pp 170-176. Colyer, H. Kamath, P. (1999) Evidence-based practice A philosophical and political analysis: some matters for consideration by professional practitioners, Journal of Advanced Nursing, Vol. 29, No. 1, pp 188-193 Dadds, M.R. Spence, S.H. (1997) Prevention and Early Intervention for Anxiety Disorders: A Controlled Trial, Journal of Consulting and Clinical Psychology Vol. 65, No. 4, pp 627-635. Dattilio, F.M. Kendall, P.C. (2000) Panic Disorder In: Dattilio, F.M. Freeman, A. Cognitive Behavioural Strategies in Crisis Interventions 2nd Edition, London, The Guildford Press. Driscoll, J. Teh, B. (2001) The potential of reflective practice to develop individual orthopaedic nurse practitioners and their practice, Journal of Orthopaedic Nursing, Vol. 5, pp 95-103 Embling, S. (2002) The effectiveness of cognitive behaviour therapy in depression, Nursing Standard, Vol. 17, Nos. 14-15, pp 33-41 Feldman, L.B. Rivas-Vazquez, R.A. (2003) Assessment and Treatment of Social Anxiety Disorder, Professional Psychology: Research and Practice Vol. 34, No. 4, pp 396-405. Gates, B. (1996) Learning Disability In: Kenworthy, N. Snowley, G. Gilling, C. (Eds) Common Foundations Studies in Nursing Second Edition, London, Churchill Livingston. Hassiotis, A. Barron, P. O’Hara, J. (2000) Mental Health Services for People with Learning Disabilities, British Medical Journal, Vol. 321, Issue 7261, pp 583-584 Hatton, C. (2002) Psychosocial interventions for adults with intellectual disabilities and mental health problems: A review, Journal of Mental Health, Vol. 11, No. 4, pp 357-373. Hewitt-Taylor, J. (2002) Evidence-based practice, Nursing Standard, Vol. 17, Nos. 14-15, pp 47-52. Department of Health (2001) Valuing People A New Strategy for Learning Disability for the 21st Century, A White Paper, London, HMSO. Department of Health (2002) Health Action Plans and Health Facilitation Good Practice Guidance for Learning Disability Partnership Boards, London, Department of Health. Heimberg, R.G. (2002) Cognitive-Behavioural Therapy for Social Anxiety Disorder: Current Status and Future Directions, Society of Biomedical Psychiatry, Vol. 51, pp 101-108. Kroese, B.S. Dagnan, D. Loumidis, K. (1997) (Eds) Cognitive-Behaviour Therapy for People with Learning Disabilities, London, Brunner-Routledge. Kroese, B.S. (1998) Cognitive-Behavioural Therapy for People with Learning Disabilities, Behavioural and Cognitive Psychotherapy, Vol. 26, pp 315-322. McInnes, E. Harvey, G. Fennessy, G. Clark, E. (2001) Implementing evidence-based practice in clinical situations, Nursing Standard, Vol. 15, No. 41, pp 40-44. Meijel, van B. Game, C. Swieten-Duijfjes, van B. Grypdonck, M.H.F. (2003) The development of evidence-based nursing interventions: methodological considerations, Journal of Advance Nursing, Vol. 48, No. 1, pp 84-92. Parry, G. (2000) Evidence-based psychotherapy In: Rowland N. Goss S. (Eds) Evidence-Based Counselling and Psychological Therapies Research and Applications, London, Routledge. Ridsdale, L (1998) (Ed) Evidence-based Practice in Primary Care, London, Churchill Livingston. Rowland, N. Goss, S. (2000) (Eds) Evidence-Based Counselling and Psychological Therapies Research and Applications, London, Routledge. Sackett, D.L. Richardson, W.S. Rosenberg, W. Hayes, R.B. (1997) Evidence-based medicine: how to practice and teach EBM, London, Churchill Livingston. Scholing, A. Emmelkamp, P.M.G. (1999) Prediction of treatment outcomes in social phobia: a cross-validation, Behaviour Research and Therapy, Vol. 37, pp 659-670 Seedhouse, D. (1998) Ethics The Heart of Health Care 2nd Edition, Chichester, Wiley. Sullivan, P. (1998) Developing evidence-based care in mental health nursing, Nursing Standard, Vol. 12, No. 31, pp 35-38

1984 Essays (1037 words) - Nineteen Eighty-Four, Ingsoc, Newspeak

1984 1. Biography George Orwell is the pen name of Eric Arthur Blair, a British writer with political conscience. He was born in India but educated in England at Eton College. He served the Indian Imperial Police in Burma from 1922 to 1927. In sick health, he returned to Europe to live in poverty as a struggling writer. Orwell joined the Republican forces in the Spanish civil war, and wrote a chilling account of this experience. He went on to write many books, mostly autobiographical, and achieved successes as a brilliant writer. 2. Synopsis The novel takes place in a theoretical and fictional dystopian totalitarian society. The story begins in London on April 4, 1984 after an atomic world war divides the world into three states. London is the capital of Oceania which is run by INGSOC(English Socialism). The controllers are called "The Party." The Party is divided into two sections, The Inner Party, and The Outer Party which are the "Rich" and the "middle-class." There is a third group of people called "The Proles," or "The Proletariat" which are the poor, and considered to be animals by the party. The main leader of this government is Big Brother. The novel is told in third person and partly first person, and is also divided into three parts. In the first part the main character and his conflicts with the world he lives in are revealed. Winston Smith is a bureaucrat who works for the government by altering history at the Ministry of Truth. He begins to ponder the reason things are so bad and commits a terrible crime. In the second part, he falls in love with Julia, and is taken in by a man named O'Brien, a member of the anti-party society called the Brotherhood. O'Brien turns out to be a true member of The Inner Party. Winston and Julia are captured and hauled off to the Ministry of Love (Minilove in Newspeak). Here, during the final part of the story, Winston is incarcerated and rehabilitated by The Party. O'Brien constantly tells Winston that Winston is crazy, and that he is trying to help him. During these sessions he reveals the true purposes of INGSOC. The party's goals can be summed up in their mottoes. "WAR IS PEACE, FREEDOM IS SLAVERY, and IGNORANCE IS STRENGTH(Orwell, 7)." 3. Theme Under the rule of INGSOC, members of The Party are engrossed in their work. It is essential that the government keeps its people happy in order to avoid rebellions and "thought crimes." Winston's greatest downfall springs from his only pleasure, his work. He found it easy to become lost in the intricacies of his duties guided only by the principles of INGSOC and his best estimate of what the Party wanted him to say. A typical task might include correcting an article in the Times, written entirely in Newspeak. In one instance he reviews an article which read: times 3.12.83 reporting bb dayorder doubleplusungood refs unpersons rewrite fullwise upsub antefiling(Dr. Tom Costa., 1). In Oldspeak (or standard English) this might be rendered: The reporting of Big Brother's Order for the Day in the Times of December 3rd 1983 is extremely unsatisfactory and makes references to nonexistent persons. Rewrite it in full and submit your draft to higher authority before filing(Dr. Tom Costa., 1). The ability of Winston to do this job can be accredited to the control of his government. Through the use of various techniques such as propaganda and the "Thought Police," Big Brother is able to not only brainwash his people, but also to reprogram them to love and serve him. 4. Structural Feature How does Orwell use distortion and irony to reveal the true motive of the IGNSOC government? By distorting the motive of a government into three elusively ironic statements, "WAR IS PEACE, FREEDOM IS SLAVERY, and IGNORANCE IS STRENGTH(Orwell, 7)." Orwell is able to convey the reality of IGNSOC's goals. "IGNORANCE IS STRENGTH" is the basic idea that ignorant people are content people. The Outer Party is kept ignorant because the truth is adjustable, and the Proles are kept content with ineffectual liberties such as love, sex, and families. "FREEDOM IS SLAVERY" breathes insecurity into the individualist. It implies that as an individual you will sink, as a

SOAP Essay Example | Topics and Well Written Essays - 250 words

SOAP - Essay Example 3 Appendicitis: patient lying still; involuntary guarding; tenderness in RLQ; other tests for peritoneal irritation positive; rebound tenderness; variation in presentation common, particularly with infants, children, and elderly (Dains, Baumann and Scheibel, 2012). 4 Pelvic inflammatory disease (PID): Abdominal tenderness, CMT and adnexal tenderness (usually bilateral); with peritonitis can also have guarding and rebound tenderness; fever and vaginal discharge common (Dains, Baumann and Scheibel, 2012). a Rationale: an abdomen or pelvis CT scan is done to diagnose the causes of abdominal pain which is often unexplained or infections (Corwin et al, 2014). Some causes of abdominal pain include infections such as appendicitis. a Rationale: the transvaginal ultrasound test looks at the reproductive organs of a woman, including the cervix, ovaries and the uterus. The test is conducted when there is an ectopic pregnancy or pelvic pain (Saccardi et al, 2012). a. Rationale: this is an ultrasound that focuses on the female pelvis. It examines a woman’s pelvic organs including the cervix, ovaries, uterus and the uterus lining (endometrium). A pelvic ultrasound is vital in diagnosing symptoms which are often felt by females such as pelvic pain. Also, a pelvic ultrasound is vital in monitoring the development and health of a fetus or embryo during pregnancy (Durham et al, 1997). Summary: (EXAMPLE GIVEN) I found this case particularly interesting because it allows me to utilize what I’ve learned during our health assessment workshop on campus I learned to evaluate the patient. By observing patient’s gait and performing test such as the Tinel’s sign test and Varus/Valgus stress test I was able to rule out possible sprain and/or tunnel syndrome (Graham & Uphold, 2003). I learned from my preceptor how to order test like x-ray and how to refer patients to other interdisciplinary

United States Department of Labor Case Study Assignment

United States Department of Labor Case Study - Assignment Example Individuals who qualify for the programs require disbursing the premium exclusively to cover a maximum of one hundred and two percent of the plan cost. COBRA assimilation by parliament took place in the year 1986, and its health benefits provisions prove accredited. The law reviews the ‘Employee Retirement Income Security Act’, the ‘Internal Revenue Code’ and the ‘Public Health Service Act’ ensure continuation of collective health coverage which would not have been in existence (United States & United States, 2007). Employers with more than 20 employees, for more than a year in the program, have the benefit of extension of health coverage, designed for their employees and their families, in cases where the coverage plans deems ending. Cobra gives out the methods by which the employees and their families can elect coverage continuation through their employers (United States & United States, 2007). Compliance with the federal laws Cobra ensures that it complies with the federal laws and any other related agencies. Its department of labor and treasury has power over private sector collective health plans. The Department of Health and Human Services expresses the operational law coverage affecting public sectors health plans. The labor section’s deductive and authoritarian accountability confines the release, and notification needs of COBRA. Number issuing done to customers in case one needs clarifications of any form. COBRA’s activities are regulated by the Internal Revenue Service, D epartment of the Treasury, it monitors their qualifications regarding, coverage and premiums, the continuation coverage needs for collective health plans. The departments responsible for implementation of these provisions are the labor and treasury departments (Jasper, 2009). How employees use this information to ensure that their right are protected Information is useful in ensuring the rights of employees are protected in that when the employees know who is legible for compensation, and in what cases they can claim compensation; there would be fewer cases of grievances in the organization. The employees are provided with contacts on who to consult in case they have any query relating to temporary extension of their health returns. Employees should always ensure that; COBRA or any other organizational plan is in use, depending on their organizational strategies to avoid any inconveniences. Continued coverage takes various forms as it may cover union members with collective bargaini ng agreement. The requirement, for employers and health plan administrators, of supplying a general notice in case they deem entitled to COBRA benefits is inevitable. COBRA subjected employees always receive notifications of their membership immediately after assimilation in a COBRA registered organization (United States & United States, 2007). In case of termination of an employee’s legibility to health coverage, the employer is responsible for providing notifications concerning the right s of the employees to COBRA continuation returns. Plan administrators wholly depend on employers for notifications concerning termination or lessened work hours to enable them successfully terminate the health benefits of the affected employees. The employer must provide information concerning the affected employee thirty days after the alteration of the employee’s contract. After which the plan administrator provide information to the employee within the fourteen days of the after

Baby Boomer Essay Example | Topics and Well Written Essays - 1000 words

Baby Boomer - Essay Example During the 1960s and 1970s, those in leadership were mainly the GI and silent generation. These generations derive their ideologies and values from the events of 1930s and 1940s, which are the Second World War and the great depression (Chapman 212). These were hard times and they are the events that shaped the ideologies of the GI and the silent generation. During these times, people normally obeyed commands and were not supposed to question. The young had no say in the society. They learned how to compromise, work hard, persevere, and sacrifice for the country. However, they were slow in bringing in changes in the society as they were conservative. The baby boomers are those born during the post war period this is a group that was influenced by the era of grand visions. This was a time when people were fighting for freedom, there was concerted effort to take man to the moon, and politicians were trying to put forward their ideologies. This generation was associated with sex, drugs, and rock and roll music. Since they were born in relatively calm period, they also attained good education. What then brought about great generational gap or ideological crisis in the 1960s and 1970s? As it can be seen, this is the period when the baby boomers were in higher education institutions while the GI and the Silent generation were in leadership. My interviewee Mr. Tayung Wong came from Taiwan to come and pursue his undergraduate degree in America. This is a clear indication of how education was being valued in America. When Mr. Wong arrived in America there were several civil rights activities taking place as he says that he watched several civil rights activities on the television. This civil rights were mainly being influenced and led by scholars in America who wanted social transformation. They were mainly the baby boomers. When Mr. Wong arrived from Asia to America he found that there were a lot of racial discrimination towards African Americans and other races by the whites. In fact he says that some form of discrimination was perpetuated against him. The GI and the silent generation had passed through the great depression and the Second World War. These were hard times. During this time there was great racial discrimination. One such example was the discrimination of the Jews by Germans leading to their extermination by Adolf Hitler. They had witnessed the worst form of discrimination in the world. The discrimination that was being witnessed in America, to them, was not something of great concern. They did not address this issue as a priority. On the other hand, the baby boomers that were born in an era of grand vision saw this as a matter of urgency that needed to be addressed by the leadership. They had the education and they could advocate their visions freely. Mr. Wong confesses that he found the American teenagers bolder in expressing their views. Mr. Wong says that he supported the movements of Dr. Martin Luther King junior that advocated for the rights of black Americans and citizens of color and he also says that he supported other African American activists. This shows that there were a lot movements advocating for equality of all residents of America. The rallies of these activists were mainly attended by the young as we see Mr. Wong, by then a university student. These are the baby boomers that were born in the era of freedom and they felt agitated when their rights were infringed. The GI and