TAYSIDE NHS BOARD FINANCIAL ASSISTANCE FOR VOLUNTARY ORGANISATIONS APPLICATION FORM PLEASE COMPLETE ALL SECTIONS OF THE APPLICATION FORM PLEASE READ THE ACCOMPANYING NOTES WHILE COMPLETING THIS APPLICATION INFORMATION RELATING TO THE FUNDING 1. a b Period for which funding is requested: (see note) Amount requested: From: To: £ 19,000 (see note) c Please tick the relevant box to specify what type of funds you are requesting: Recurring Funds d Non Recurring Funds If this money is for a specific project, please tick the relevant box to specify the period for which funds are requested: 1 Year e Name of Organisation: 2 Years 3 Years ANGUS CARDIAC GROUP “GET UP AND GO” INFORMATION RELATING TO PROJECT / SERVICE 2 a Project / Service Title: (if different to organisation) ANGUS ACTIVITY PROGRAMME FOR PEOPLE WITH A LONG-TERM CONDITION b Purpose for which funding is being sought: (see note) VOLUNTEERS CURRENTLY DELIVER SEATED EXERCISE IN GROUPS WITHIN SHELTERED HOUSING COMPLEXES, CARE HOMES AND THE HOMES OF THOSE WHO ARE HOUSEBOUND. THIS WAS A PILOT DELIVERED USING FUNDING FROM LONG-TERM CONDITIONS ALLIANCE SCOTLAND (LTCAS). THE PILOT HAS BEEN 1 EXTREMELY SUCCESSFUL. HOWEVER, CESSATION OF FUNDING HAS RESULTED IN THIS COMING TO AN END. THIS APPLICATION FOR FINANCIAL ASSISTANCE WOULD PROVIDE 10HRS/WEEK OF VOLUNTEER CO-ORDINATION SUPPORT AND CONTRIBUTE TOWARDS VOLUNTEER EXPENSES. THE FUNDING WOULD ALSO PROVIDE 6HRS/WEEK OF FUNDING TO ALLOW CO-ORDINATION OF ACTVITY PROGRAMMES FOR PEOPLE WITH LONG-TERM CONDITIONS, WHEN MOVING FROM HOSPITAL REHABILITATION TO THE COMMUNITY AND ALSO FOR REFERRAL OF PATIENTS TO ACTIVITY PROGRAMMES WITHIN ANGUS COUNCIL LEISURE SERVICES. 2 c What evidence of need has been determined or identified? (see note) THE VOLUNTEERS WITHIN THE SERVICE ARE NEW TO VOLUNTEERING. THE VOLUNTEERING OPPORTUNITY – DELIVERING SEATED EXERCISE OPPORTUNITIES FOR PEOPLE IN GROUPS AND/OR IN THEIR OWN HOMES – IS AN INNOVATIVE DEVELOPMENT. VOLUNTEERS REPORT THE NEED TO BE SUPPORTED AT THIS TIME. IT IS ALSO IMPORTANT TO CONTINUE TO DEVELOP THE INVOLVED VOLUNTEERS IN TERMS OF PROVIDING APPROPRIATE EXERCISES TO THOSE IN THEIR CARE. THERE IS CURRENTLY NO PROVISION FOR THE TRAINING/ SUPPORT/DEVELOPMENT OF THESE VOLUNTEERS. FOLLOWING THE EVALUATION OF THE ACTVITY PROGRAMME IT BECAME CLEAR THAT THERE WAS CONFUSION AMONGST HEALTH PRACTITIONERS AS TO THE DIFFERENT TYPES OF EXERCISE REFERRAL AVAILABLE IN ANGUS. THERE IS ALSO LACK OF UNDERSTANDING ABOUT THE ELIGIBLITY OF PATIENTS WITH A LONG-TERM CONDITION ATTENDING THE AVAILABLE EXERCISE OPPORTUNITIES. THERE IS A NEED TO CO-ORDINATE THIS PROVISION, REDUCE BUREAUCRACY, AND FACILITATE PATIENT ATTENDANCE. 2 d Who will be the target group / population? e.g. areas of deprivation, ethnicity (see note) PEOPLE IN ANGUS WITH ANY LONG-TERM CONDITION e What health improvement outcomes will this project achieve? e.g. impact on health status, inequalities (see note) PEOPLE WILL BE HAPPIER, HEALTHIER AND MORE ABLE TO MANAGE THEIR LONGTERM CONDITION/S, THUS RELIEVING A BURDEN OF CARE ON NHS SERVICES f What outputs / activity will be required to achieve these outcomes? (see note) TO PROVIDE EXERCISE OPPORTUNTIES FOR EVERYONE IN ANGUS WITH A LONGTERM CONDITION. THIS HAS BEEN SHOWN TO IMPROVE THE SELF-MANAGEMENT OF ANY HEALTH CONDITION. IT IS ALSO ANTICIAPTED, FROM BEST EVIDENCE, THAT PEOPLE WILL FALL LESS, AND THAT DEMENTIA COULD BE DELAYED AS A RESULT OF THIS INTERVENTION. IN ORDER TO ACHIEVE THIS WE WOULD: PROVIDE APPROPRIATE TRAINING TO THOSE WITHIN THE PROJECT DELIVERY SERVICE. EMPLOY A VOLUNTEER CO-ORDINATOR TO RECRUIT AND SUPPORT VOLUNTEERS. g How does your service contribute towards local targets/local plans such as the NHS Tayside Corporate Plan and the Single Outcome Agreement? (see note) THE SERVICE WILL FACILITATE INACTIVE PEOPLE TO BECOME MORE ACTIVE MORE OFTEN WITH A COMMENSURATE SAVING IN GP VISITS BECAUSE THEY WILL BE HAPPIER AND HEALTHIER. h Will this project involve partnership working? Please describe: (see note) 3 ANGUS CARDIAC GROUP HAS A PROVEN TRACK RECORD OF WORKING WITH OTHER GROUPS, WINNING THE 2012 LTCAS AWARD FOR SELF-MANAGEMENT PARTNERSHIP OF THE YEAR. ANGUS CARDIAC GROUP WILL CONTINUE TO WORK WITH ANGUS CHP AND ANGUS COUNCIL LEISURE SERVICES, AS WELL AS OTHER LOCAL PEER SUPPORT GROUPS TO ENSURE THAT ALL VOLUNTEERS CONFORM TO BEST PRACTICE WORKING, AND THAT DEVELOPMENT OF ANY EXERCISE OPPORTUNITIES WILL FOLLOW BEST EVIDENCE. i How will the project be monitored and evaluated? (see note) NUMBER OF VOLUNTEERS NUMBER OF PARTICIPANTS PATIENT SATISFACTION IMPROVEMENT IN HEALTH/MOBILITY BETTER MENTAL HEALTH CONTRIBUTION TO SELF-MANAGEMENT DEVELOPMENT OF EXERCISE REFERRAL OPPORTUNITIES j Number of current service users, if applicable: (see note) How many people will benefit directly from this project? 300 NEW PARTICIPANTS 10 ADDITIONAL VOLUNTEERS k 2 l Proposed start date, if applicable: (see note) JUNE 2013 In what way is the proposed activity additional to existing provision? THERE IS CURRENTLY VOLUNTEER SUPPORT/DEVELOPMENT AVAILABLE FOR THE ACTIVITY PROGRAMME FUNDED BY A SHORT TERM GRANT. THIS ENDS IN MAY 4 2013. THERE IS NO ALLOCATED STAFF TO DEVELOP THE REFER2EXERCISE PROGRAMMES WITHIN ANGUS COUNCIL LEISURE SERVICES AND THE STAFF FROM HEALTH IMPROVEMENT WHO SUPPORTED REFER2EXERCISE ARE NO LONGER IN POST. THIS ACTIVITY WILL ENSURE THAT THE TARGETED GROUP OF PEOPLE WITH LONG-TERM CONDITIONS HAVE ACCESS TO EXERCISE OPPORTUNITIES AND THAT ANY DEVELOPMENTS ARE UNDERTAKEN IN PARTNERSHIP WITH THE NHS AND PATIENT GROUPS. m How do you let people know about the work of your organisation and how will you inform people about this activity? RECRUIT VOLUNTEERS FROM PEER SUPPORT GROUPS AND THROUGH ADVERTISING WITHIN VOLUNTEER ACTION ANGUS AND LOCAL PRESS TARGET LOCAL HEALTH PRACTITIONERS E.G. COPD SERVICE, HEART FAILURE SERVICE TO REFER PARTICPANTS ELIGIBLE FOR THE HOUSEBOUND SERVICE RESIDENTS OF CARE HOMES AND SHELTERED HOUSING COMPLEXES WILL BE INFORMED ABOUT GROUP ACTVITY BY CARE HOME MANAGERS/WARDENS. n Do you know of any other organisation that does similar work? Yes No If yes, in what way is your project different? VOLUNTEER GOLD DELIVER SOME SEATED ACTVITY IN ANGUS BUT HAVE DECIDED TO FOCUS ON A BEFRIENDING SERVICE FOR ISOLATED INDIVIDUALS IN THE BRECHIN AREA. OUR PROGRAMME WILL BE ANGUS WIDE AND DELIVER A SEATED ACTVITY PROGRAMME FOR A SPECIFIED TIME. PATIENTS WILL THEN BE ENCOURAGED TO 5 EXERCISE THEMSELVES EITHER AT HOME AND/OR WITHIN A LOCAL GROUP IF POSSIBLE. THERE IS CURRENTLY NO LONGER ANY DEDICATED STAFF TO FACILITATE AND DEVELOP THE REFER2EXERCISE PROGRAMMES. INFORMATION RELATING TO THE ORGANISATION 3 a Date of formation of organisation: 1992 b Is the organisation a registered charity? Yes c Registration Number / company status? d Geographic area covered? (see note) e What are the main objectives of the organisation? No ANGUS ANGUS CARDIAC GROUP IS A PATIENT LED SUPPORT GROUP ESTABLISHED WITH A VIEW TO SUPPORTING CARDIAC CARE AND REHABILITATION IN ANGUS. IT HAS BEEN THE LEAD ORGANISATION, IN PARTNERSHIP WITH ANGUS CHP, ANGUS COUNCIL LEISURE SERVICES AND ANGUS COPD GROUP AMONGST OTHERS, IN DEVELOPING EXERCISE OPPORTUNITIES FOR PEOPLE IN ANGUS WITH A LONG-TERM CONDITION. 6 INFORMATION RELATING TO THE ORGANISATION’S OFFICERS (see note) 4 a Name of Chair / Convenor: GORDON SNEDDEN Home address of Chair / Convenor: 26 NORTH LOCH ROAD Please note this information will remain confidential. FORFAR DD8 3LS b Telephone Number: 01307 462045 Name of Secretary: JENNIFER HEDGE Home address of Secretary: SUTTIESIDE ROAD, Please note this information will remain confidential. FORFAR DD8 3NH c Telephone Number: 01307 477718 Name of Treasurer: KATHLEEN FERRIER Home address of Treasurer: 67 SOUTH STREET Please note this information will remain confidential. FORFAR DD8 2BS d Telephone Number: 01307 468579 Name of contact person for this project: (see GORDON SNEDDEN note) Designation: CHAIR OF ANGUS CARDIAC GROUP Correspondence Address: 26 NORTH LOCH ROAD 7 FORFAR, DD8 3LS 4 e Telephone Number: 01307 462045 Email Address: acg@gordonsnedden.co.uk Hours of Availability: 24/7 How many people are on the Management Committee at a local level? (see 12 (ACG note) COMMITTEE 4 (PROJECT COMMITTEE) f How many service users are on the Management Committee? (see note) g How many staff and volunteers does the organisation have? Full Part Time? 2 Volunteer? 37 2 Total? (CONSULTANCY Time? BASIS) 5 a Does your organisation carry out Disclosure Checks on appropriate staff? (see note) Yes b 6 No Are Disclosure Checks reviewed routinely? (see note) Yes c No Does your organisation have policies on the following: Volunteering Policy? Yes No Child Protection? Yes Vulnerable Adults? Yes No Equality? Yes No No How did you hear about the NHS Funding for Voluntary Organisations? SUSAN WILSON, GENERAL MANAGER, ANGUS CHP 8 IMPLICATIONS FOR HEALTH (see note) 7 How will the project deliver on the following criteria? a Improve the health of the people of Angus/Tayside? PARTICIPATION IN PHYSICAL ACTVITY IS KNOWN TO IMPROVE BOTH PHYSICAL AND MENTAL HEALTH, AND, AS A RESULT, PEOPLE ARE MORE ABLE TO MANAGE ANY LONG-TERM CONDITION THEY MAY HAVE. STRENGTH AND BALANCE TRAINING IS ALSO KNOWN TO REDUCE FALLS. EXERCISING IN GROUPS ALSO FACILITATES SOCIAL CONTACT b Reduce health inequalities and promote social inclusion? PEOPLE WITH LONG-TERM CONDITIONS CANNOT ACCESS PHYSICAL ACTIVTY OPPORTINITIES AS READILY AS PEOPLE WITH NO HEALTH DIFFICULTIES. THERE IS ALSO A NEED TO ENSURE THAT ANY EXERCISE PROGRAMMES ARE DELIVERED IN A SAFE, EFFECTIVE AND TIMELY MANNER. c Improve patient / public and partnership involvement and strengthen partnership arrangements? ANGUS CARDIAC GROUP WILL WORK WITH ANGUS CHP, ANGUS COUNCIL LEISURE SERVICES AND OTHER LOCAL GROUPS TO PROMOTE THE DELIVERY OF THIS ACTIVITY PROGRAMME. 9 d How does the organisation work with local communities to deliver its service? LOCAL COMMUNITIES AND PEER GROUPS WILL BE CONSULTED e Support people living in their own community and enable them to take more responsibility for their own health? EVAILAUTION OF THE ACTIVITY PROGRAMME TO DATE HAS SHOWN THAT PEOPLE WHO HAVE PARTICIPATED FEEL HAPPIER, HEALTHIER AND MORE ABLE TO MANAGE THEIR HEALTH CONDITION. FINANCIAL INFORMATION (see note) 8 a What end of year financial accounts are to be included with this application? ANGUS CARDIAC GROUP’S LAST FULL YEAR ACCOUNTS (PLEASE NOT THAT BECAUSE OF ANGUS CARDIAC GROUP’S CONSITUTION, FUNDS RAISED BY THE GROUP CANNOT BE USED TO HELP AND SUPPORT PEOPL/GROUPS WITH OTHER HEALTH CONDITIONS – THIS CAN ONLY BE DONE USING FUNDING OBTAINED FROM OTHER SOURCES). b Please provide projections covering the period for which the funds are being requested. c Please provide details of funding requested from other bodies / agencies, including funds provided to the organisation through Service Level Agreements and any outstanding applications awaiting decisions. Body / Organisation Date of Application Amount Requested Outcome 10 d Please provide a brief description of other fund-raising activities for this project e.g. coffee mornings etc and the amount you anticipate to raise? AS STATED ABOVE, MONIES RAISED BY ACG THROUGHOUT THE YEAR CANNOT BE USED TO SUPPORT THIS PROJECT. Anticipated Amount £ SUPPORTING INFORMATION (see note) 9 Please use this checklist to indicate what you are enclosing with your application: Constitution / Legal Status * Yes Annual Report Yes Full Audited Accounts * Yes Additional Statistical Information Yes Projected Income and Expenditure * Yes Equality Policy * Yes Volunteering Policy* Yes Business Plan Other External project evaluation * These are mandatory enclosures and failure to enclose these documents will delay or stop consideration of your application for financial support. If we already have a copy please state this. You may attach any other useful information in support of your application. 10 Any other supporting information or comments: (see note) A GREAT DEAL OF WORK AND COMMITMENT BY A LARGE NUMBER OF PEOPLE HAS BEEN PUT IN TO THIS PROJECT OVER THE LAST THREE YEARS. THE PROJECT HAS RECEIVED MANY ACCOLADES AS WELL AS THE SCOTLAND WIDE AWARD PREVIOUSLY MENTIONED. IT WOULD BE DISASTROUS IF THE PROJECT 11 WAS TO LOSE ITS IMPETUS NOW. 11 I apply for funding in respect of expenditure to be incurred over the proposed funding period on the activities described in this application. I certify that, to the best of my knowledge and belief, the statements made in this application are true and the information provided is correct. I also agree to ensure that the NHS support is acknowledged within the organisation’s income and expenditure accounts. (see Signature: note) Name in Full: Gordon Snedden Designation: Chairman Date: 13.05.13 On completion of the application please return to: Corporate Services Manager Angus CHP St Margaret’s House Forfar DD8 1WS FOR CHP/HEALTH BOARD USE Application Received: Date Recurring Application: Non-Recurring Application: Period of Funding: Copies to: Finance Date Other NHS Staff Date Comments received: Outcome: 12 Organisation informed of outcome: Date TAYSIDE NHS BOARD FINANCIAL ASSISTANCE FOR VOLUNTARY ORGANISATIONS NOTES FOR APPLICANTS PLEASE COMPLETE ALL SECTIONS OF THE APPLICATION FORM General Note 1 1 a 1 b 1 1 c d Note 2 2 b If it is not possible to complete the form electronically, please complete the application form in black ink and write clearly in block capital letters. INFORMATION RELATING TO THE FUNDING Period for which funding is being requested and amount requested: The dates given should reflect the organisation's financial year. Please remember to complete the amount requested. Please specify what type of funds you are requesting: Are the funds being requested on a nonrecurring basis (one off funds) or a recurring basis (year on year for the foreseeable future) or for a specified, set period of time i.e. 1, 2 or 3 years. INFORMATION RELATING TO PROJECT / SERVICE Purpose for which funding is being sought: It is important to state clearly the purpose to which the requested funds will be put e.g. a contribution towards running costs, specific training initiatives, development / extension to present service, staffing costs etc. 2 c 2 d Who will be the target group / population? 2 e What health improvement outcome(s) will this project achieve? What evidence of need has been determined or identified? This section should include any type of information that indicates a need for the service. This can include evidence of needs assessment that the organisation (or another source) has taken forward or determined. 13 2 f What outputs / activity will be required to achieve these outcomes? For the above, please provide details about what your organisation is trying to achieve and which groups it is aiming to help. We also need to know what benefit to health will result from this funding, including the aspect of health you aim to address or improve. What improvement outcomes are expected and how will the project achieve its outcomes through the activities to be taken forward. 2 g How does your service contribute towards local targets/local plans such as the NHS Tayside Corporate Plan and the local Single Outcome Agreement? 2 h Will this project involve partnership working? Please describe: The NHS works across Tayside so please state how your project/service will aim to address the targets and plans for your local area i.e. Angus, Dundee or Perth & Kinross, and whether this will include working in partnership with other voluntary or statutory agencies. You can view a copies of the plans at the NHS Tayside website or the relevant Council website for the Single Outcome Agreement. 2 i How will the project be monitored and evaluated? Details of monitoring and evaluation processes should be included as well as the timescale for reporting to Angus CHP/Tayside NHS Board. 2 j Number of current service users, if applicable: How many people will benefit directly from this project? The number of clients currently supported by the organisation should be included and, if your application is for a development of an existing service, the anticipated number of new clients that will directly benefit from this project should be stated. 2 k Proposed start date, if applicable: The proposed start date should refer to when the project will commence within the financial year for which funds are being requested. Note 3 INFORMATION RELATING TO THE ORGANISATION 3 Geographic area covered? Please state Angus, Dundee, Perth & Kinross or Tayside. d Note 4 INFORMATION RELATING TO THE ORGANISATION’S OFFICERS 4 Details of Officers: Please provide details of the current Office Bearers. Their home addresses should be provided rather than an office address. This information will remain confidential. 4 d Contact Person: This should be the person who is able to discuss the work of the organisation and the application in detail. It would be helpful to state a particular time of day when it is most suitable for contact to be made. 4 e How many people are on the Management Committee at a local level? 14 4 f How many Service Users are on the Management Committee? 4 g How many staff and volunteers does the organisation have? Please tell us about the number of people on your management committee at local level and the staff / volunteers that support your organisation’s work. 5 a If appropriate, have all staff and / or volunteers received Disclosure Checks? 5 b Are Disclosure Checks reviewed routinely? All staff and volunteers providing an NHS Service or working with children will be expected to have received an Enhanced Disclosure check. If your organisation is not required to undertake disclosure checks, please provide evidence to support this. IMPLICATIONS FOR HEALTH 7 Please complete this section to give us information about how this project / service might meet the criteria listed. FINANCIAL INFORMATION 8 8 The purpose in requesting financial information is to confirm the viability of the organisation to complete its objectives and operate as a going concern. Organisations should not be wholly reliant on statutory funding and it is expected that they will raise funds by other methods. Voluntary organisations must acknowledge Angus CHP/NHS Tayside’s contribution within their audited or independently examined income and expenditure accounts, either on the face of the accounts or contained within the notes attached to the accounts. a What end of year financial accounts are to be included with this application? A copy of your organisation's most recent Audited / Independently Examined Accounts together with any relevant notes to the accounts must be submitted. If the audited accounts are those of your national organisation then they should be accompanied by financial statements pertaining to the local organisation in respect of the same period duly certified by the organisation’s Treasurer or other office bearer. A similar situation might exist if you are a large local organisation running a number of selfcontained projects. If this is your organisation’s first application to Angus CHP/Tayside NHS Board or there has been a lapse in funding, then the last two years Audited / Independently Examined Accounts will be required, including local statements if applicable. The financial position for the current year must also be provided and should include: a budget for each of the income / expenditure items, together with the actual income / spends to an appropriate month end and a forecast of income / spend to the year end. It would be helpful if the detailed format was similar to that provided in your annual statements or financial reports. An example of a suitable template is given at appendix A. 8 b Please provide projections covering the period for which funds are requested. A statement giving details of the local organisation's Projected Income & Expenditure for the period to which the request relates should be included. If the funding request is for more than one year then the projection should show the requirements for each year of the project. This statement should show the various sources of income and expenditure broken down e.g. staff costs (including employer's costs), administration costs, travel costs, training costs, accommodation costs, meeting expenses and other operational costs etc, to a similar detail as provided in your annual statements or financial reports. The format in the template at appendix A may be helpful in providing this information. 15 8 c Please provide details of funding requested from other bodies / agencies, including funds provided to you through Service Level Agreements? Details should be included in respect of funding sought from other sources e.g. statutory (local authority) and non-statutory (local Trust Funds). This should include the amount requested and the outcome, if known. 8 d Please provide a brief description of other fund-raising activities for this project e.g. coffee mornings etc and the amount you anticipate to raise? Give details of activities that your organisation undertakes to raise funds of a non-statutory nature e.g. coffee mornings, jumble sales, sponsored walks etc. Please give an indication of the amount of funding expected to be raised by these methods. SUPPORTING INFORMATION 9 It is essential that a copy of your organisation's constitution/legal status be submitted if one has not previously been submitted or it has changed since its last submission. To process your application organisations not previously funded must enclose a copy of the Constitution/Memorandum and Articles, Annual Report, 2 years of audited accounts, the Projected Income and Expenditure statement and the organisation’s Equality and Volunteering Policies. You may also submit a business plan and any other relevant supporting information. 10 Any other supporting information or comments: Other information/comment can be provided. If you have included additional statistical information in Section 9 please refer to it in this section. 11 Signature: The application should be signed by one of the Office Bearers or a Responsible Officer. PLEASE REMEMBER TO SIGN AND DATE THE APPLICATION. IF COMPLETED ELECTRONICALLY, A HARD COPY WITH A RESPONSIBLE OFFICER’S SIGNATURE SHOULD ALSO BE PROVIDED. 16 Appendix A Example Financial Template: Please insert rows within the relevant sections as appropriate Organisation Project Title Income & Expenditure Statement Year Ending 31 March 2010 Source & Destination Descriptions 2009-10 Current Year Exp to Date Sep-08 Budget Year-end Forecast 2010-11 2011-12 2012-13 Projection Projection Projection INCOME SOURCES: Total Income EXPENDITURE ITEMS: 0 0 0 0 0 0 Total Expenditure 0 0 0 0 0 0 Surplus / -Deficit Reserves Brought Forward Depreciation Gain / Loss on Assets Reserves Carried Forward 0 0 0 0 0 0 0 0 0 NOTES: An excel spreadsheet of this template can be provided on request, if desired. 17