FRENCH FEDERATION OF

CARDIOLOGY

Fiscal years 2017 to 2021

January 2023

2

Executive Summary

An incomplete overhaul of the statutes, and strategic thinking on the use

of funds and reserves to be accelerated

The French Federation of Cardiology (FFC) brings together 27 regional cardiology

associations that provide patient support and carry out preventive actions on the ground,

supported by 260

clubs cœur et santé

[Heart and Health Clubs] covering the whole country.

The Court

’

s audit concerns the period covering the terms of office of two presidents of

the federation, during which several modernisation projects were launched: the creation of a

development plan for the first time, the creation of research and regional mobilisation services,

the setting up of specialised committees, Don en confiance [Donate with Confidence] labelling,

and the plan to reform the statutes. Nevertheless, several issues brought tensions within the

Board to the surface. These internal conflicts led to a significant delay in defining the new

development plan and delayed the reform of the statutes.

Although reform is necessary, it is also blocked by the federation

’

s reluctance to change

its governance by putting more focus on associative democracy, as requested by the Ministry

of the Interior. This raises the question about the organisation of the FFC’s governance, which

contains seeds of dysfunction, notably by granting double votes to certain members of the

Board.

Behind the internal conflicts and the question of governance, it is also, in reality, the

association

’

s strategy and prioritisation of its actions that is at stake. Is it moving towards

objectives of a learned society intended to raise funds primarily for research, and which is then

intended to maintain a governance restricted to cardiology professors? Or is it a federation that

promotes prevention above all, and intends to lead local non-profit organisations that rely on

volunteers, which would then require, for the sake of consistency, that these be given greater

access to its decision-making bodies? Between these two polar models, it is up to the

federation to clarify in its strategic plan, currently under construction, the weight it intends to

give in the medium term to its various programmes (regardless of fluctuations linked to the

recent pandemic), so as to provide donors with a clear message on the actions it intends to

promote. It must therefore endeavour to clearly prioritise its actions within an action plan with

quantitative and qualitative objectives and a precise timetable. It should set a multiyear budget

for each of these actions. Appropriate governance will be self-evident, and sources of conflict

will be contained accordingly.

In addition, the federation has begun to take greater account of ethical issues in its

operations, although a number of institutional reforms have not yet been implemented.

Finally, despite the recommendations made in several audits

1

, the federation

’

s current

management still lacks a risk management system. The audits conducted during the Court

’

s

investigation highlighted numerous anomalies which demonstrate a lack of internal control.

The FFC

’

s cash position, which was already high before the health crisis, has increased

sharply over the past two financial years (€24 million in 2020

-2021) due to the combined effect

of a sharp drop in expenditure on social programmes and an increase in funds raised. This

high level of cash makes it necessary to reflect on the FFC

’

s investment policy and, above all,

to commit to spending on social programmes, which is what donors expect. While a certain

level of prudent reserves is obviously acceptable, given the uncertainties that characterise

1

See audit reports by two firms in 2015 and 2020 and Don en confiance reports, a private labelling body, between

2019 and 2022.

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legacies, which constitute an important source of financing for the federation, this must be set

at the most appropriate level following an objective analysis. Defining the new development

plan and implementing it within a strategy for the use of these funds donated by the public is

therefore not only urgent in order to clarify the federation

’

s position in terms of principles, but

also to accelerate the effective use of the funds raised.

An annual use-of-funds statement whose cost allocation rules slightly

overestimate the magnitude of social programmes

Only the appendices to the use-of-funds statements for the period under review,

approved each year at the same time as the accounts, contain information concerning the

expenses to be allocated exclusively or partially to social programmes, fundraising costs and

operating costs.

These appendices should therefore have served as a frame of reference for the FFC,

particularly for allocating expenditure to the use-of-funds statements, which was not the case.

The adjustments made by the Court show a decrease in expenditure attributable to social

programmes.

With regard to the use of funds, compliance with the objectives set out in donation

appeals and therefore with donors’ wishes was not perfect due to technical difficulties. This is,

in particular, at least the case for the annual campaign focused on supporting research. Finally,

the Court

’

s audit revealed inconsistencies between the accounts and the financial information

published for several financial years. This is all the more problematic as some of these

inconsistencies have been pointed out in previous reports, some of which are old, reflecting

the federation

’

s difficulty in questioning its operating methods.

For these various reasons, the financial information provided to donors does not give

them a sufficiently accurate picture of how the funds are used.

Dynamic fundraising, but insufficient implementation of GDPR obligations

The donations received (excluding legacies and gifts) have been increasing since the

2018-

2019 financial year reaching €6.5 milli

on at the end of June 2021, at the expense of a

15% increase in fundraising costs over the period under review. The service provider rigorously

manages the processing of donations and the issue of tax receipts, and access to the donor

database shows a satisfactory level of security.

However, compliance with the General Data Protection Regulation (GDPR) is still lacking

when it comes to obtaining consent or the data retention period.

Social programmes strongly affected by the health crisis and unequal

development of actions

The cardiovascular disease prevention programme, where spending fell by 45%

between 2016 and 2021, has been heavily affected by the health crisis. The programme for

funding cardiology research has been professionalised during the period, while benefiting from

an increased budget until 2019-2020: research projects are now all selected following calls for

proposals by the scientific committee. However, many research projects fell behind schedule

during the health crisis, calling for increased monitoring of their implementation.

The FFC has launched several initiatives to improve the coordination of regional

associations. The network indicators showed a steady increase in network activity over the

early part of the audit period, although the health crisis subsequently affected them.

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The momentum of the FFC

’

s social programmes therefore appears to be mixed. All were

affected by the health crisis. Expenditure on social programmes thus fell by €3.7 million (

-37%)

between 2018 and 2021.

By clarifying its strategy and mobilising its cash flow, the FFC must endeavour to regain

positive momentum for the social programmes that it intends to prioritise.