WORLDWIDE_RADIOLOGY - Accounts

The trustees present their report and financial statements for the year ended 30 November 2021.

The trustees have adopted the provisions of the Statement of Recommended Practice (SORP 2019) “Accounting and Reporting by Charities” (FRS 102) in preparing the annual report and accounts of the charity.

The financial statements have been prepared in accordance with the accounting policies set out in note 1 to the financial statements and comply with the charity's governing document, the Companies Act 2006 and "Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) (effective 1 January 2019)".

This report has been prepared in accordance with the provisions applicable to companies entitled to the small companies exemption.

The objects of the charity are to:-

• Relieve sickness, to protect and preserve health, and to save lives by improving access to quality diagnostic imaging, particularly in under-served areas of low and middle income countries.

• Advance education in all areas relevant to diagnostic imaging, particularly for limited resource settings, in particular, but not exclusively by commissioning or undertaking research into disease epidemiology and management in the context of diagnostic imaging, particularly for limited resource settings, and to publish the useful results of such research.

The trustees have paid due regard to guidance issued by the Charity Commission in deciding what activities the charity should undertake.

The description under the headings "Achievements and performance" and "Financial review" meets the company law requirements for the trustees to present a strategic report.

Review of Activities and Future Developments

Introduction

Demand for the WWR range of services continued to grow as we progressed through the financial year 2021. WWR is extremely proud to be able to provide support for diverse projects across a range of geographies in Sub-Saharan Africa and beyond.

Our project pipeline continues to build and addresses the broad base of our organizational objectives; from research to training and clinical support. The support from a growing group of volunteers has been extraordinary and we continue to look for ways to leverage our expertise at scale. We are therefore particularly pleased to be able to report strong recruitment of volunteers. Below we highlight some of the projects in which WWR has been involved during the financial year 2021. Many of these projects have lifespans that we expect to continue into the medium term, as we are particularly committed to build long term relationships with our partners and beneficiaries.

Programme delivery

Point of care Ultrasound Training

Our first pilot course in point of care ultrasound (POCUS) for doctors was delivered successfully in Ghana. This course was delivered in-country over a period of two separate weeklong courses in June and October 2021, hosted by our partner institution in Ghana, The University of Health and Allied Sciences in Ho. Course delivery in-country was provided by four WWR expert volunteers who provided hands-on training for a cohort of ten students. Course material and certification were developed in partnership with the University of Salford, UK. A larger team of volunteers contributed to pre-course online training material and remote supervision of Ghanaian participants over the full nine-month training period. We are extremely excited by the success of this pilot and the enthusiastic participation by both our volunteers and the trainee cohort.

We are also proud to report our acceptance into the competitive UKAID funded Tropical Health and Education Trust HPCD program. This is a Global Health Partnership mentoring program aimed at UK charities and institutions linking with overseas Healthcare providers.

Under guidance of the program, we are now developing a 3-year partnership with the University of Health and Allied Sciences in Ghana for the further development of this POCUS training leading to wider dissemination of POCUS skills. The early success of the pilot course has proven invaluable in making a strong case for this three-year partnership. We are happy to report early traction in bringing this longer-term partnership to fruition.

Remote Radiology Support

We continue to develop our approach to remote radiology support. During the year we have worked with several Teleradiology platform providers to help surface some of the many operational issues that need to be resolved to be able to provide a seamless service into a challenging digital health environment. Internet connectivity, data governance and local data security issues all need to be addressed before we can scale this valuable service, aimed at supporting both clinical care and education.

Remote Radiology Support (continued)

WWR is meeting the challenges posed by providing this service in a systematic manner and we hope to report progress in implementing a small-scale service in the coming months. In Ghana, the WWR Project lead for this Remote Radiology support project conducted a successful site visit at the Komfo Anokye teaching hospital. The findings from this field work and close collaboration with our selected PACS platform provider will inform both in-country and remote program development through 2022. In time we hope to build a regional network, linking in radiologists from other partner sites such as The Gambia. Working together remotely - in theory - has never been so easy and there is a great opportunity in radiology to benefit patients and network healthcare workers in understaffed regions.

To this end, we have also established memoranda of understanding with key partner institutions, recruited a core group of expert volunteers to deliver this remote support and selected our PACS platform partner. Momentum continues to build.

In-country Radiology Support

We supported our first UK Postgraduate Radiology Trainee on a 6-month placement at our partner site in The Gambia. On this placement our volunteer enjoyed a local collaboration with sonographers and radiographers from both the Medical Research Council (MRC) clinic, and the Edward Francis Small Teaching Hospital. This was to help deliver patient care, but also to help train both imaging and clinical staff and explore opportunities and needs for ongoing support. This was a hugely successful placement, both for our partners and our volunteers, and we look forward to further developing this partnership and supporting similar placements for other UK trainees, interested in a career in Global Health Radiology.

In Malawi, our In-country Radiologist partner and part-time WWR volunteer at the Kamuzu University of Health, completed her first year of work for WWR; producing a wide-ranging needs assessment to identify key priority areas for support into 2022 and coordinating the remote WWR volunteer teaching to medical students.

Under guidance of a second WWR volunteer radiologist, medical students from Liverpool and Malawi subsequently evaluated this online learning. We are delighted that the outcomes of this evaluation will be presented at an international global Health conference in 2022.

We are also supporting the development of a new curriculum for training of radiologists in Malawi. This post-graduate program will be starting in September 2022. We hope to be able to leverage our work on Remote Radiology (as described above) to support this new training program in Malawi.

Research

WWR continues to support research both at an institutional and individual level.

For example, as part of the IMPALA (Lung health in Africa research consortium) programme, hosted by the Liverpool School of Tropical Medicine (LSTM), for which WWR volunteers supported data collection and analysis into the application of Computer aided diagnosis for Tuberculosis on Chest Xrays. This has led to the Publication of two peer reviewed scientific papers, creating visibility for WWR in the academic Global Health community.

WWR also continues its support for the African Research Collaboration on Sepsis, also hosted at LSTM; exploring the role of Point of care ultrasound in patients presenting with Sepsis. Three WWR expert volunteers completed data analysis for the Malawi study patient cohort (one of three research sites) and one of these volunteers’ presented findings at an international scientific sepsis conference in October 2021. Volunteers continue to provide remote training support to study sites in Uganda and Gabon.

Advocacy and communications

One of Worldwide Radiology’s key objectives is advocacy for the delivery of Imaging diagnostics to low resource settings. We continue to open new channels of communication, through partner organizations, social media and WWR events.

WWR was proud to participate in a podcast with “Radcast”, sharing its work with an audience of over 600 junior doctors interested in Medical Imaging.

WWR and partners from Kenya, Ghana and Malawi were invited to present to the Royal College of Radiologists annual conference in October 2021. A special thanks to our sponsors at this event: 4Ways Healthcare.

We also hosted our first “meet and greet” Zoom event in October of this year, which was a huge success. This allowed us to bring both our partners and volunteers together to share our experiences and look for new ways to make an impact. We shall be hosting more of these events going forward.

Funding

Program selection and likely sources of funding are inevitably linked, however, WWR are committed to pursuing only those projects that are completely aligned to our core values and mission. In the near term we rely on donations and grant funded research programs to generate our income. Without the generosity of our volunteer’s our work would be impossible. As our pipeline of projects grows, however, we will need to look for new sources of support.

Our ecosystem of partners is increasingly important to our program delivery. For example, we are pleased to have secured a Kosmos handheld US machine for the POCUS training in Ghana, donated to us by Echonous, the product company. We have also received Viewing station monitors for Queen Elizabeth Central Hospital in Malawi, donated to us by 4Ways Healthcare. We also owe special thanks to our partners at Collective Minds who have provided both PACS platform access and technical support in the development of our remote teleradiology offering.

Technical and legal advice in the development phase was kindly offered by 4Ways Healthcare and by CIMAR.

We have also made significant progress on sourcing support from grant giving organizations. We need to do more here, but we anticipate that as we demonstrate our impact, and our projects scale our funding will scale with it.

Fundraising activities are a growing part of life at WWR and a huge thank you goes to all those individual donors in our network and to those that have organized funding events to ensure WWR’s valuable work endures and grows.

WWR funding for both operational and field programs is highly dependent on both donations and grant giving organizations. The latter is aligned very closely to specific projects that WWR engage with and will result in restricted sources of funds. We have ongoing costs associated with our operations that must be maintained from unrestricted sources of funds. These costs relate to legal oversight, accounting services, insurance premiums, communications, and IT support. Our WWR Financial policy states that our level of reserves should be maintained at £3,000. At the close of the financial year on the 30/11/2020 our reserves met this requirement.

Risk policy

The trustees has assessed the major risks to which the charity is exposed, and are satisfied that systems are in place to mitigate exposure to the major risks.

Plans for future periods

The demand for WWR services continues to grow. Our current pipeline has a broad mix of demand. Opportunities exist for WWR to further leverage our domain expertise into a range of partnerships that have elements of both remote and local support. In addition, we look for opportunities to increase recruitment of in country and remote radiology volunteers. The successful completion of our point of care ultrasound pilot has laid the foundations for the further development of an accredited course. Our first major partner site will be in Ghana, but we see opportunities to scale this across the region, with specific expression of interest from our partners in The Gambia already under discussion.

Increasingly, our offering is falling into two clear areas of demand: 1. Point of care ultrasound training for clinicians who are not radiology experts, expanding patient access to imaging beyond radiology departments and 2. Radiology specific education and clinical support. We see opportunities to deliver this both remotely and via in-country support structures. Our focus in 2022 will be to strengthen and develop these distinct service offerings for scalability.

The charitable company was incorporated on 1st November 2017 in England and Wales and is limited by guarantee. It is governed in accordance with its Memorandum and Articles dated 21st June 2018 and is a registered company (number 11042080) and charity (number 1178885).

Trustees

The trustees who have served during the year and since the year end are set out below. Trustee appointments are made at the Annual General Meeting of members and they hold office until they retire or are removed.

Concluding remarks

WWR has uncovered huge unmet demand for our services. Increasingly the challenge is on how we scale to meet this demand in a sustainable way. This requires careful program planning and the successful recruitment of volunteers both in the UK and in-country. Focusing our efforts on point of care ultrasound training and on Remote and In-country Radiology support is a natural outcome of our early work. This focus is helping us build practical and sustainable models for organizational operations, for volunteer recruitment and for the development of funding strategies. The funding environment in Global Health remains challenging. However, the vision for universal health coverage and the high-level international recognition of the important role of imaging diagnostics in delivering on that vision gives us cause for optimism. We believe our early mover experience and our emphasis on long-term collaborations and sustainable impact will continue to gain support from the broader funding community. We look forward to the challenges ahead with growing optimism.

The trustees confirmed that they have complied with the duty in section 4 of the Charities Act 2011 to have due regard to the Charity Commission’s general guidance on public benefit “Charities and Public Benefit”.

The trustees' report, including the strategic report, was approved by the Board of Trustees.

I report to the trustees on my examination of the financial statements of Worldwide Radiology (the charity) for the year ended 30 November 2021.

As the trustees of the charity (and also its directors for the purposes of company law) you are responsible for the preparation of the financial statements in accordance with the requirements of the Companies Act 2006 (the 2006 Act).

Having satisfied myself that the financial statements of the charity are not required to be audited under Part 16 of the 2006 Act and are eligible for independent examination, I report in respect of my examination of the charity’s financial statements carried out under section 145 of the Charities Act 2011 (the 2011 Act). In carrying out my examination I have followed all the applicable Directions given by the Charity Commission under section 145(5)(b) of the 2011 Act.

I have completed my examination. I confirm that no matters have come to my attention in connection with the examination giving me cause to believe that in any material respect:

accounting records were not kept in respect of the charity as required by section 386 of the 2006 Act; or

the financial statements do not accord with those records; or

the financial statements do not comply with the accounting requirements of section 396 of the 2006 Act other than any requirement that the accounts give a true and fair view which is not a matter considered as part of an independent examination; or

the financial statements have not been prepared in accordance with the methods and principles of the Statement of Recommended Practice for accounting and reporting by charities applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102).

I have no concerns and have come across no other matters in connection with the examination to which attention should be drawn in this report in order to enable a proper understanding of the financial statements to be reached.

The statement of financial activities includes all gains and losses recognised in the year.

All income and expenditure derive from continuing activities.

The company is entitled to the exemption from the audit requirement contained in section 477 of the Companies Act 2006, for the year ended 30 November 2021.

The directors acknowledge their responsibilities for complying with the requirements of the Companies Act 2006 with respect to accounting records and the preparation of financial statements.

The members have not required the company to obtain an audit of its financial statements for the year in question in accordance with section 476.

These financial statements have been prepared in accordance with the provisions applicable to companies subject to the small companies regime.

Worldwide Radiology is a private company limited by guarantee incorporated in England and Wales. The registered office is 6 Hope Place, Liverpool, Merseyside, L1 9BG.

The financial statements have been prepared in accordance with the charity's Memorandum and Articles of Association, the Companies Act 2006 and "Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) (effective 1 January 2019)". The charity is a Public Benefit Entity as defined by FRS 102.

The charity has taken advantage of the provisions in the SORP for charities applying FRS 102 Update Bulletin 1 not to prepare a Statement of Cash Flows.

The financial statements are prepared in sterling, which is the functional currency of the charity. Monetary amounts in these financial statements are rounded to the nearest £.

The financial statements have been prepared under the historical cost convention. The principal accounting policies adopted are set out below.

At the time of approving the financial statements, and having due regard to the impact of Covid-19, the trustees have a reasonable expectation that the charity has adequate resources to continue in operational existence for the foreseeable future. Thus the trustees continue to adopt the going concern basis of accounting in preparing the financial statements.

Unrestricted funds are available for use at the discretion of the trustees in furtherance of their charitable objectives.

Restricted funds are subject to specific conditions by donors as to how they may be used. The purposes and uses of the restricted funds are set out in the notes to the financial statements.

Cash donations are recognised on receipt. Other donations are recognised once the charity has been notified of the donation, unless performance conditions require deferral of the amount. Income tax recoverable in relation to donations received under Gift Aid or deeds of covenant is recognised at the time of the donation.

No amount is included in the accounts for volunteer time in line with the SORP (FRS 102).

All expenditure is accounted for on an accruals basis and has been classified under headings that aggregate all costs related to the category. Expenditure is recognised where there is a legal or constructive obligation to make payments to third parties, it is probable that the settlement will be required and the amount of the obligation can be measured reliably. It is categorised under the following headings:

• Costs of raising funds includes investment management fees.

• Expenditure on charitable activities includes cost of providing financial support to those in need.

• Other expenditure represents those items not falling into the categories above.

Irrecoverable VAT is charged as an expense against the activity for which expenditure arose.

Support costs are those that assist the work of the charity but do not directly represent charitable activities and include governance costs and other administrative costs. They are incurred directly in support of expenditure on the objects of the charity.

The analysis of these costs is included in note 7.

Tangible fixed assets are initially measured at cost and subsequently measured at cost or valuation, net of depreciation and any impairment losses.

Depreciation is recognised so as to write off the cost or valuation of assets less their residual values over their useful lives on the following bases:

The gain or loss arising on the disposal of an asset is determined as the difference between the sale proceeds and the carrying value of the asset, and is recognised in the statement of financial activities.

At each reporting end date, the charity reviews the carrying amounts of its tangible assets to determine whether there is any indication that those assets have suffered an impairment loss. If any such indication exists, the recoverable amount of the asset is estimated in order to determine the extent of the impairment loss (if any).

Cash and cash equivalents include cash in hand, deposits held at call with banks, other short-term liquid investments with original maturities of three months or less, and bank overdrafts. Bank overdrafts are shown within borrowings in current liabilities.

The charity has elected to apply the provisions of Section 11 ‘Basic Financial Instruments’ and Section 12 ‘Other Financial Instruments Issues’ of FRS 102 to all of its financial instruments.

Financial instruments are recognised in the charity's balance sheet when the charity becomes party to the contractual provisions of the instrument.

Financial assets and liabilities are offset, with the net amounts presented in the financial statements, when there is a legally enforceable right to set off the recognised amounts and there is an intention to settle on a net basis or to realise the asset and settle the liability simultaneously.

Basic financial assets, which include debtors and cash and bank balances, are initially measured at transaction price including transaction costs and are subsequently carried at amortised cost using the effective interest method unless the arrangement constitutes a financing transaction, where the transaction is measured at the present value of the future receipts discounted at a market rate of interest. Financial assets classified as receivable within one year are not amortised.

Financial assets, other than those held at fair value through income and expenditure, are assessed for indicators of impairment at each reporting date. Financial assets are impaired where there is objective evidence that, as a result of one or more events that occurred after the initial recognition of the financial asset, the estimated future cash flows have been affected.

If an asset is impaired, the impairment loss is the difference between the carrying amount and the present value of the estimated cash flows discounted at the asset’s original effective interest rate. The impairment loss is recognised in net income/(expenditure) for the year.

If there is a decrease in the impairment loss arising from an event occurring after the impairment was recognised, the impairment is reversed. The reversal is such that the current carrying amount does not exceed what the carrying amount would have been, had the impairment not previously been recognised. The impairment reversal is recognised in net income/(expenditure) for the year.

Financial assets are derecognised only when the contractual rights to the cash flows from the asset expire or are settled, or when the charity transfers the financial asset and substantially all the risks and rewards of ownership to another entity, or if some significant risks and rewards of ownership are retained but control of the asset has transferred to another party that is able to sell the asset in its entirety to an unrelated third party.

Basic financial liabilities, including creditors and bank loans are initially recognised at transaction price unless the arrangement constitutes a financing transaction, where the debt instrument is measured at the present value of the future payments discounted at a market rate of interest. Financial liabilities classified as payable within one year are not amortised.

Debt instruments are subsequently carried at amortised cost, using the effective interest rate method.

Trade creditors are obligations to pay for goods or services that have been acquired in the ordinary course of operations from suppliers. Amounts payable are classified as current liabilities if payment is due within one year or less. If not, they are presented as non-current liabilities. Trade creditors are recognised initially at transaction price and subsequently measured at amortised cost using the effective interest method.

Financial liabilities are derecognised when the charity’s contractual obligations expire or are discharged or cancelled.

The charity is an exempt charity within the meaning of schedule 3 of the Charities Act 2011 and is considered to pass the tests set out in Paragraph 1 Schedule 6 Finance Act 2010 and therefore it meets the definition of a charitable company for UK corporation tax purposes.

The cost of any unused holiday entitlement is recognised in the period in which the employee’s services are received.

Termination benefits are recognised immediately as an expense when the charity is demonstrably committed to terminate the employment of an employee or to provide termination benefits.

In the application of the charity’s accounting policies, the trustees are required to make judgements, estimates and assumptions about the carrying amount of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from these estimates.

The estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting estimates are recognised in the period in which the estimate is revised where the revision affects only that period, or in the period of the revision and future periods where the revision affects both current and future periods.

Travel

Subscriptions

Administration and marketing support

Office expenses

Bank charges

Other expenses

Advertising and marketing

IT software and consumables

Independent examination fees

Accountancy

Trustee indemnity insurance

The average monthly number of employees during the year was:

African Research Consortium on Sepsis (ARCS) - The National Institute of Health Research (NIHR) Global Fund supported programme is hosted by the Liverpool School of Tropical Medicine and delivers training and research support at three sites in Gabon, Malawi and Uganda.

A trustee has provided funds for the purchase of Ultrasound equipment for training purposes.

Donations of £4,525 (2020 £nil) were received from trustees during the year.

There were no other related party transactions during the year (2020 £Nil).