DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
**Registered number: 07450026 Charity number: 1143189**
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED**
## **(A company limited by guarantee)**
## **UNAUDITED**
**TRUSTEES' REPORT AND FINANCIAL STATEMENTS**
**YEAR ENDED 30 NOVEMBER 2021**
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **CONTENTS**
||Page|
|---|---|
|**Reference and administrative details of the company, its Trustees and advisers**|1|
|**Trustees' report**|2 - 14|
|**Independent examiner's report**|15 - 16|
|**Statement of financial activities**|17|
|**Balance sheet**|18 - 19|
|**Statement of cash flows**|20|
|**Notes to the financial statements**|21 - 38|
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **REFERENCE AND ADMINISTRATIVE DETAILS OF THE COMPANY, ITS TRUSTEES AND ADVISERS FOR THE YEAR ENDED 30 NOVEMBER 2021**
|**Trustees**|D Doughty (deceased 11 October 2021)|
|---|---|
||R Stancliffe|
||M Smeeth|
||G Manning, Acting Chair|
||J Rhys-Griffith|
||D Mackay (appointed 6 January 2020)|
||Dr R Hixson (appointed 6 January 2020)|
|**Company registered**
**number**
07450026
**Charity registered**
**number**
1143189
**Registered office**
8 King Edward Street
Oxford
Oxfordshire
OX1 4HL
**Principal operating**
**office**
Cranbrook House
287 - 291 Banbury Road
Oxford
Oxfordshire
OX2 7JA
**Chief executive officer**
R Stancliffe
**Accountants**
Wellers
Independent Examiners
8 King Edward Street
Oxford
OX1 4HL||
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DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **TRUSTEES' REPORT FOR THE YEAR ENDED 30 NOVEMBER 2021**
The Trustees present their annual report together with the financial statements of the The Centre for Sustainable Healthcare Limited for the year 1 December 2020 to 30 November 2021. The Annual report serves the purposes of both a Trustees' report and a directors' report under company law. The Trustees confirm that the Annual report and financial statements of the charitable company comply with the current statutory requirements, the requirements of the charitable company's governing document and the provisions of the Statement of Recommended Practice (SORP) applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS102) (effective 1 January 2019).
Since the company qualifies as small under section 382 of the Companies Act 2006, the Strategic report required of medium and large companies under the Companies Act 2006 (Strategic Report and Directors' Report) Regulations 2013 has been omitted.
## **Objectives and activities**
## **a. Policies and objectives**
The Trustees confirm that they have referred to the guidance contained in the Charity Commission’s general guidance on public benefit when reviewing the Charity’s aims and objectives, and in planning future activities and setting future policies, therefore have complied with the duty in section 17 of the Charities Act 2011. In line with Charity Commission guidance our objectives are determined by our defined charitable objectives
1. Transforming healthcare for a sustainable future.
2. Ensuring that health is safeguarded in a time of resource restraint.
3. Educating healthcare professionals and others about links between health and the environment.
## **b. Strategies for achieving objectives**
CSH Strategies for achieving Objectives are:
1. engaging healthcare professionals, patients and the wider community in sustainability and the links between health and environment
2. engaging other industries and organisations in the healthcare sector
3. assessing current knowledge, barriers and opportunities for sustainable healthcare
4. improving research into more sustainable options
5. helping the NHS to reduce its carbon footprint.
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DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **Objectives and activities (continued)**
## **c. Activities undertaken to achieve objectives**
1. developing and running programmes and tools that can help to engage healthcare professionals and others.
2. sharing ideas and knowledge with other organisations to engage them with sustainable healthcare.
3. running networks to enable natural communities in healthcare to share ideas and questions.
4. working to include sustainability in medical education via curriculum development and other areas.
5. developing courses in various elements of sustainable healthcare and teaching them.
6. carrying out reviews of current research and other information on barriers and opportunities for sustainable healthcare.
7. identifying and/or carrying out research into more sustainable options for healthcare.
8. measuring the carbon footprint of services, medical products and clinical pathways.
9. developing standardised methodology for carbon footprinting and measuring the triple bottom line in healthcare.
10. promote planting trees as a mechanism to engage staff, patients and visitors with sustainability.
11. working with NHS sites to make the links between health and the environment through the NHS Forest projects.
12. improving access to green space through green health routes with the aim of improving health.
## **d. Volunteers**
CSH continues to benefit from volunteers who have worked on central projects and tasks. During 2021 we carried out our planned expansion of the volunteers programme, by increasing numbers, grouping them into batches, offering a standardised induction, and asking for a minimum six month commitment (4 8 hours per week), or full time for one month. We had 21 volunteers and 12 students on elective placements.
## **Achievements and performance**
## **a. Review of activities**
Despite some continued disruption to activities due to Covid 19, CSH has had an extremely busy year with both ongoing and new projects.
Our Sustainability School training programme has continued to be very popular and is beginning to bring in a steady revenue stream. We have added 3 new courses during 2021 and over 1000 healthcare professionals participated in the training days this year. We also worked with Health Education England to design short courses that are available free to everyone in the NHS.
The Green Surgery Challenge took place this year, our first Specialty Competition. It had excellent participation and feedback and produced some highly impactful case studies.
In the 2020/21 tree planting season we sent out more than 4,000 free saplings to NHS sites across the UK and by the close of 2021, healthcare sites had ordered a further 12,500 NHS Forest trees to plant in the 2021/22 season.
With nearly half a million pounds from the Green Recovery Challenge Fund, there has been a lot of recruitment and then a huge amount of work in the Green Space team. Our Nature Recovery Rangers worked to engage people – patients, healthcare staff and community members – in nature-related activities, while also improving biodiversity. They have made a huge difference to the sites where they have been based and the programme is being requested at other NHS sites.
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DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
**TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **Achievements and performance (continued)**
In October we held our first online NHS Forest Conference, with the theme of ‘an equitable recovery for people and nature', attracting 350 delegates, including healthcare staff, outdoor space charities, researchers and artists.
## **Staffing changes**
In 2021, CSH continued growth in all programmes with 13 new staff:
1. In the Green Space Programme we employed 7 new staff members and some site assistants.
2. In the Clinical Programme we employed a Specialties Lead, a new Fellow in Quality Improvement and a Green Ward manager. For courses, a Courses manager and full-time admin person, and a full-time carbon modelling assistant.
## **Green Space Programme in 2020/21**
In 2021 the Green Space for Health programme received a major grant from the Government’s Green Recovery Challenge Fund. This has allowed us to ramp up NHS Forest tree planting and to take the programme in new and exciting directions.
This year saw the start of a completely new NHS Forest initiative with the appointment of three Nature Recovery Rangers, employed by us but embedded at NHS sites in Bristol, Liverpool and London. The rangers work to engage people – patients, healthcare staff and community members – in nature-related activities, while also improving biodiversity. All three have been an energetic and inspiring presence at their sites, and strong advocates for nature. An early win was the promotion of Plantlife’s national No Mow May campaign, which led to the creation of extensive wildflower meadow areas at all of their sites, and was rewarded at Liverpool’s Broadgreen Hospital with the unexpected appearance of bee orchids, marsh orchids and pyramidal orchids (a first record for Liverpool). Ranger activities have included wildlife-friendly gardening, food growing, nature walks, wildlife home construction and ecological surveys. At each site the rangers have also overseen substantial green space projects. At Southmead Hospital in Bristol, the ranger worked with volunteers and nursing staff to develop a therapeutic space for neuropsychologic patients, while our Liverpool ranger worked with children excluded from school and their staff, to revive a courtyard wildlife garden at Broadgreen Hospital. At Mount Vernon Cancer Centre in London, our ranger has overseen completion of a green space enhancement programme initiated by CSH, that includes an accessible ‘woodland walkway’, and a newly refurbished garden for the chemotherapy suite with a specially designed wooden shelter where patients can spend time outdoors during treatment. Our London ranger also initiated a very successful site-wide gardening competition, involving more than 100 staff in nurturing and bringing to life green patches close to their work areas.
Because of Covid restrictions it was at first difficult to bring volunteers on to the sites, but over time the rangers have involved a wide variety of local community groups. We have also been able to extend our programme to include two interns working under their supervision, with more placements planned for 2022. We have been excited by the success of the ranger project in engaging staff and delivering biodiversity improvements on the ground, as well as moving green space and nature higher up the agenda at hospital sites. Each of our partner NHS trusts is keen to retain their rangers beyond the life of the current project, and Southmead Hospital has already secured charitable funding to do so.
In the 2020/21 tree planting season we sent out more than 4,000 free saplings to NHS sites across the UK. We continued to publicise this offer throughout the year, and by the close of 2021, healthcare sites had ordered a further 12,500 NHS Forest trees to plant in the 2021/22 season. We have been impressed by the diversity of our sites’ planting plans, which reflect the full range of tree planting benefits, from flood prevention to the creation of wildlife corridors and support for exercise and relaxation. Among many highlights were the planting of 1,000 trees across four mental health and learning disability hospitals in the North of England by Cumbria,
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DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **Achievements and performance (continued)**
Northumberland, Tyne and Wear NHS Foundation Trust, to connect different planting areas, create greener walking routes and support the wellbeing of service users and staff. In Oxford we worked with partners at Earthwatch Europe to plant a ‘Tiny Forest’ – a small, dense, fast-growing woodland – at Littlemore Hospital. We were also delighted to support staff at Great Ormond Street Hospital for Children in London with the donation of a Japanese maple to celebrate their London to Glasgow cycle relay for the COP26 Climate Summit.
Our 2020 research, Space to Breathe, supported by the Health Foundation, explored health staff’s experience of green space at their sites, and its influence on wellbeing, and we were keen to build further on its insights. Our grant from the Green Recovery Challenge Fund enabled us to commission the social enterprise Natural Academy to deliver a short programme of wellbeing in nature sessions at five healthcare sites. Fifty-two health staff took part in these sessions and a further 10 staff – two at each site – received training to provide sessions themselves, ensuring the project’s long-term legacy. The sessions and training have both been enthusiastically received by health staff and we are currently evaluating both this and the Nature Recovery Ranger project, in collaboration with our academic partner at the University of Suffolk.
In October we held our first online NHS Forest Conference, with the theme of ‘an equitable recovery for people and nature', attracting 350 delegates, including healthcare staff, outdoor space charities, researchers and artists. In her keynote address, Judy Ling Wong, Honorary President of the Black Environment Network, told us: “I propose that we can be stimulated and supported in our search for a 21st century context for wellbeing through looking at different cultural visions of nature, and be inspired to creatively retrieve what is missing in our lives in the green spaces that the NHS Forest provides to staff and to the public.” The conference showcased innovative green space work at a wide variety of health sites, from a food growing project in South London to a rooftop farm in Boston, and culminated with our NHS Forest Awards to celebrate impressive work at five of our sites. In the course of the year our team visited 12 health sites across the country, facilitating information gathering and consultation, for the development and launch of our new, redesigned NHS Forest website in early 2022. This will help us support many more health sites in developing their green space.
Our Communities Programme was very active in 2021. With support from the Postcode Local Trust, we took our Health Routes project to Botley, Oxford, where work with residents, a social prescribing link worker, and Vale of White Horse District Council supported use of green space on the doorstep. This included the co-design of a walking map; wildlife walks led by local specialists; and work with volunteers to establish a walking group for residents, which now meets on a weekly basis to explore local green spaces.
Our Health Routes project also piloted a new approach in Wales where we worked with partners at Plantlife to set up a ‘Meadows Health and Wellbeing Route’ as part of the Magnificent Meadows Cymru project, funded by the Welsh Government. In collaboration with the hospital, Ysbyty Gwynedd, in Bangor, and the North Wales Wildlife Trust, we established a signed route connecting this health site to beautiful local meadows at nearby Eithinog Nature Reserve.
Throughout 2021 we continued to work with Cherwell District Council to support the FAST programme. This innovative initiative works to encourage children, parents and others to enjoy sports as a family and become more physically active. It includes access to free indoor and outdoor Youth Activator sessions and affordable access to local leisure centres and clubs. CSH evaluation activities are focused on the collection of qualitative data to help understand the experiences of participating families. As of December 2021, over 6,900 individuals (1,900 families) had signed up for the FAST card, and of the families currently engaging with the programme, 22% live in the 30% most deprived wards in the district. Prior to starting the programme, only 15% of participating families reported being active together five or more times a month, compared to 52% of participating families responding at the time of our follow up survey.
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DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
**TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **Achievements and performance (continued)**
## **Green Space Staff changes**
At the start of 2021 we were sad to say goodbye to Sarah Dandy, founder of the NHS Forest, who has now returned to teaching. Carey Newson became the Green Space Director, leading an expanded team. Andriele Madison, already a member of our team, became our Communities Lead, with oversight of our Health Routes project, our work on Magnificent Meadows Cymru and the FAST programme. Early in the year we welcomed our Communications and Engagement Officer, Vicki Brown, who leads on developing the NHS Forest website and conference; our Outreach Officer, Miriam Dobson, who co-ordinates the NHS Forest network, including tree planting; and our Partnerships Project Manager, Athene Reiss, who manages the rangers and oversaw delivery of the wellbeing in nature sessions. In April we were joined by our Nature Recovery Rangers, Karen MacKelvie, Fiona Megarrell and Phoebe Webster, and in the autumn the first of our interns, Asia Pryjda and Daisy Tickner started work. Throughout the year we were grateful for the support of our volunteer walk leaders, Rachel Griffiths, Inga Williams and Janet Hemingway.
_The Government's Green Recovery Challenge Fund was developed by Defra and its Arm's-Length Bodies. It is being delivered by The National Lottery Heritage Fund in partnership with Natural England, the Environment Agency and Forestry Commission._
The CSH Sustainability School continued to offer Green Space and Health training via the online learning platform. This is a learning package aimed at health professionals, which focuses on the benefits of nature for health and the implications for healthcare, with a strong emphasis on practical action.
## **Clinical Programme: Highlights in 2020/21**
The team continued to grow with appointment of a second in house QI Education Fellow, who took over from the first Fellow in August 2021, a Courses Manager, Hayley Pinto, courses admin assistant, Natalie Oman, a Specialties Lead, Catherine Floyd, and a Green Ward Manager, Rachel McLean. In addition, we continue to provide mentoring and supervision to Fellows and Scholars, including a second Welsh Clinical Leadership Fellowship post and fellows in Anaesthesia, Surgery and scholars in Ophthalmology.
## **Sustainable Specialties**
We had a busy year in our sustainable specialties programmes, with the launch of the Green Surgery Challenge, a specialty adaptation of our Green Ward Programme. Five fantastic surgical teams from across the UK received mentoring from CSH, culminating in a high-profile online judging event. Projects spanned introduction of reusable equipment to redesign of patient pathways to reduce unnecessary tests and admissions. The Challenge was delivered in partnership with NIHR and the Royal Colleges of Surgeons of England and Edinburgh, and built on work started by Chantelle Rizan, through her three-year Sustainable Surgery Fellowship, which she completed this July. Chantelle’s research has led to multiple publications and has laid the foundations for sustainable surgery going forward.
Also in July, Dr Chris Allen became the second Fellow to complete the one-year Fellowship in Environmentally Sustainable Anaesthesia, a partnership between CSH, Newcastle-upon-Tyne Hospitals and the Association of Anaesthetists. Chris has carried forward initiatives to reduce the environmental harms from inhaled anaesthetic agents (potent greenhouse gases), including setting up the Nitrous Oxide project to identify and address gas wastage in collaboration with pharmacist Alifia Chakera in Scotland and our Welsh Clinical Leadership Fellow, Amarantha [https://sustainablehealthcare.org.uk/what-we-do/sustainable-specialties/anaesthetics/nitrous-oxideproject] . Chris has handed the fellowship baton to Dr Jason Ghandi, who continues the work.
Our second Welsch scholar in sustainable Ophthalmology funded by Thea Pharmaceuticals completed her scholarship at the end of July, conducting a carbon footprint analysis of single use versus disposable
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DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
**TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **Achievements and performance (continued)**
tonometers. She also started a survey on the attitudes of cataract surgeons and scrub nurses to theatre waste. CSH also welcomed another sustainable Ophthalmology scholar at Barts Hospital who looked at the environmental impact of conducting the first assessment of patients’ cataracts as a telephone consultation instead of a face to face outpatient visit.
2021 saw the launch of a brand new Sustainable Specialty, Green Endoscopy, with the appointment in September of Fellow, Dr Robin Baddeley, as well as the revival of early work in kidney care, with the launch of a national UKKA Sustainable Kidney Care committee.
There is a general growth in interest and activity within specialties and we are delighted to welcome new staff member, Catherine Floyd, who has joined us as Clinical Specialties Lead.
## **Sustainable Clinical Practice**
Following our work over the past couple of years to demonstrate how clinical sustainability and quality improvement can be brought together, it has been exciting to see ‘SusQI’ start to be embedded in Trusts – including in Newcastle and Dorset. There has also been interest in the approach from the Institute for Healthcare Improvement (a leading QI organisation based in the US) who invited Frances and Olivia to contribute to an expert meeting on Climate Action in Care Delivery, and then to present at the IHI Forum in December.
Another area of exciting developments has been in Wales. CSH has partnered with the Cardiff and Vale Health Board (C&V) to support annual Welsh Clinical Leadership Fellows in Sustainable Healthcare. Working with the first Fellow, Amarantha Fennell-Wells, in 2020-21, CSH supported the creation of the Green Health Wales network and hosted their dynamic and engaging launch event in June. Taking over from Amarantha in September, Dr Stacey Harris has continued with an enormous amount of energy, connecting local and national action on everything from medical education and inhaler prescribing to governance and reporting. The launch of CSH & C&V’s ‘SFERIC’ group sustainability scholars programme at the end of the year will provide further support for decarbonisation and SusQI in Wales.
## **Sustainability in QI Education**
The SusQI Education Project, funded by Health Education England, The Health Foundation and Kings College London, continues to go from strength to strength as it enters its third year.
In the first two years, the project ran pilots in undergraduate and postgraduate education in medicine, nursing and dentistry to demonstrate that sustainable healthcare principles can be included in QI teaching. Detailed evaluation has found that the inclusion of sustainability enhances students’ motivation for QI and develops confidence and skills for improving sustainability in practice. The project is now transitioning to a spread phase, providing high-quality open access resources (see susqi.org), supported by online courses for QI practitioners and educators, with more hands-on support available through our “beacon site” programme.
## **Education**
Our Sustainability School training programme has continued to grow. We have also worked with Health Education England to provide short, free training to all NHS staff.
## **Online Short Courses**
This year we added three new courses, Sustainable Primary Care, Sustainable Mental Healthcare and Public Health Leadership for Sustainability. Over 1000 clinicians, managers and researchers have passed though our courses since we first launched in June 2020, and the feedback has been excellent.
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## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **Achievements and performance (continued)**
_“A knowledgeable faculty provide real-life examples of how sustainability projects can improve the NHS for patients and the environment”_
For 2022 we have launched discounted rates for lower-band staff and for groups. We have also added a Sustainability Café, open to all foundation-level course participants.
Foundation-level courses
- Introduction to Sustainable Healthcare (multidisciplinary)
- Green Space and Health (multidisciplinary)
- Sustainable Primary Care
- Sustainable Mental Healthcare
- Sustainable Dentistry
- • Public Health Leadership for Sustainability
- Technical courses
- Carbon Footprinting for Healthcare
- Sustainable Quality Improvement
- Teaching Sustainable Quality Improvement
## **Free online modules**
CSH partnered with Health Education England’s e-Learning for Healthcare to create free e-learning modules for all staff groups. Each module takes approximately 30 minutes to complete and includes downloadable certificates.
1. _‘Building a Net Zero NHS'_ raises awareness about the demands and opportunities of a sustainable healthcare system, using short, animated films, interactive activities that reinforce key information and case studies of successful projects.
2. _'Sustainability in Quality Improvement'_ will empower staff to integrate financial, social, and environmental measures into their QI projects. Due February 2022
3. _'Sustainable Dentistry'_ applies sustainability principles to the dental setting. Due May 2022.
4. _‘All our Health: Climate Crisis’_ offers an overview of the health effects of global warming and what actions health staff can take. Due April 2022.
## **Board Level Training**
New interactive 90-minute workshops for executive-level staff in which we outline the expectations of the NHS Net Zero Plan, highlight what is unique about leadership for sustainability and explore how to inspire people to lead and measure change.
## **Carbon Modelling**
Detailed carbon footprint analyses of the direct and indirect greenhouse gas emissions of organisations, products and services/
## **Digital Transformation**
CSH’s carbon modelling team in collaboration with PD Transformation and funded through Q by the Health Foundation and NHS England and NHS Improvement developed a step-by-step guide and carbon calculator to estimate the Greenhouse Gas (GHG) emission savings of (avoided) patient travel due to switching from inperson outpatient or GP appointments to remote consultations. The guide has been developed for health
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## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
**TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **Achievements and performance (continued)**
professionals, quality improvement leads and estates, sustainability and practice managers at hospitals and GP practices. It can be used for a specific clinical pathway, a clinical department, or the whole organisation.
The carbon modelling team also provided a comparative carbon footprint analysis of a digital healthcare solution during its feasibility phase.
## **South Warwickshire**
Discharge to Assess (D2A) is an innovative approach which sees health and social care professionals work together to help people return home or to care homes sooner from hospital. In South Warwickshire, the Covid-19 response has galvanised collaborative working across the system to support Discharge to Assess, re-admission avoidance and new models of out of hospital care. CSH has been working closely with NHS partners to measure the impact of the Covid-19 changes to Discharge to Assess on work patterns, travel and resource use, alongside clinical and social outcomes.
## **Carbon footprint of NHS sight tests**
CSH has been commissioned by NHS England and NHS Improvement to analyse the annual carbon footprint of NHS sight test services provided by five Optometry practices in the North West of England. As far as we know, this has been the first carbon footprint analysis of NHS optometrist services.
## **Sustainability in Veterinary Practice**
Commissioned by the Royal College of Veterinary Surgeons (RCVS), CSH is working closely with the College’s Practice Standards Group on embedding sustainability into the RCVS’s Practice Standards scheme (PSS). The PSS’s sustainability module will help veterinary practices to monitor and reduce their environmental impact.
## **b. Fundraising activities/income generation**
CSH has managed to secure new funding and to diversify our income streams to take advantage of emerging opportunities, achieving a booked income of £780,963.
The six main sources of income for this period were: The Green Recovery Challenge Fund, Health Education England, The Health Foundation, King’s College London, Cherwell District Council, and Wales Cymru.
Additional smaller pots of money were secured from: Cardiff and the Vale Health Board, Acute Trusts, NHS Improvement, Association of Anaesthetists, Thea Pharmaceuticals, Ufonia, Perseptive, Tree Sponsorship for the NHS Forest and via delegate fees for training Workshops/ conferences.
## **Financial review**
## **a. Going concern**
After making appropriate enquiries, the trustees have a reasonable expectation that the company has adequate resources to continue in operational existence for the foreseeable future. For this reason, they continue to adopt the going concern basis in preparing the financial statements. Further details regarding the adoption of the going concern basis can be found in the Accounting Policies.
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## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **b. Reserves policy**
We are working towards achieving a sustainable reserve, in accordance with best practice, to cover three months of operational costs. This includes, where possible, building in a contingency to cover for costs or timings that may alter. In line with many organisations, this has been particularly relevant during 2020 given the inevitably unpredictable Covid and post Covid working scenarios, and the knock on effect of this for charities working closely with the NHS. In addition, we are aiming to build in elements of budget requests to cover our core costs where possible and refocusing our activities to raise core funding.
In November 2021 our monthly operating costs were £70,000, so we have built up a reserve of 1 month during this year.
## **c. Surplus**
This financial year (Dec 2020 – Nov 2021) the charity had an income of £780,963 and expenditure of £703,969 resulting in an operating profit for the year amounting to £76,994.
## **d. Principal funding**
The bulk of CSH’s funding is in the form of restricted grants or contract funding which includes a contribution to the Charity’s overheads.
CSH has increased and continues to increase its revenue sources from unrestricted funding through the expansion of its online CSH Sustainability School, delivering commissioned training and developing commissioned e learning modules, expanding the Green Ward Competition programme and offering consultancy in carbon modelling.
CSH will continue to scrutinise new grant funding proposals to ensure that there is a proportionate contribution to the Charity’s overheads.
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**THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
**TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **Structure, governance and management**
## **a. Constitution**
The company is registered as a charitable company limited by guarantee and was set up by a Memorandum of Association on 24/11/2010.
The company is constituted under a Memorandum of Association dated 24/11/2010 and is a registered charity number 1143189.The company changed its Memorandum and Articles to better reflect its work after consultation with NCVO and is currently constituted under a Memorandum of Association and Articles dated 15/07/2011.
The principal object of the company is to provide:
1. The promotion of health for the benefit of the public in any part of the world.
2. The advancement of education for the benefit of the public in any part of the world by supporting the application and implementation of research findings to improve health and healthcare.
3. The conservation, protection and enhancement of the physical and natural environment by the prudent use of natural resources for the public benefit.
## **b. Methods of appointment or election of Trustees**
The management of the company is the responsibility of the Trustees who are elected and co opted under the terms of the Articles of Association.
## **c. Organisational structure and decision-making policies**
The Trustees meet once every quarter, either face to face or by phone conference (as permitted). The Director of CSH provides a draft agenda and financial update 2 weeks before the meetings, with opportunity for each Trustee to contribute suggested items for the agenda. Meetings are also attended by at least one other employee of CSH – usually the financial lead. Decisions are taken at the meeting unless it is deemed important to get input from anyone not present, in which case a clear set of options is circulated to all and responses are collated via email.
## **d. Policies adopted for the induction and training of Trustees**
A Skills Audit has been used, which enables the Trustees to identify their own strengths and weaknesses and helps to identify training needs for existing individuals and gaps, which might be filled by new Trustees.
## **e. Related party relationships**
As set out in the application to the Charities Commission and accepted by them, Rachel Stancliffe is both a Trustee and the Director of CSH, receiving a regular salary as such. As governed by the Articles, she will absent herself for any meeting or any part of the meeting in which a conflict of interest may arise.
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**THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
**TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **Structure, governance and management (continued)**
## **f. Risk management**
The Trustees have assessed the major risks to which the company is exposed, in particular those related to the operations and finances of the company, and are satisfied that systems and procedures are in place to mitigate our exposure to the major risks.
A system of assessing risks to the programmes has been put in place with a traffic light marking (red, amber and green) to highlight projects at risk during any stage of their progress. The risk assessment for projects is reviewed quarterly and the overall risk profile of the company is reviewed annually.
## **Plans for future periods**
## **Future developments**
For our green space programme, the activities planned for 2022 have continued to focus on larger projects. We have applied for a large Trees Call to Action Fund grant which would enable continued growth of our Green Space programme. Working in the national arena continues to benefit the organisation as a whole, as well as growing CSH’s impact in this increasingly prominent field. We shall continue to prioritise:
- Re-design and launch of our NHS Forest website
- Developing a more extensive programme of green health routes
- Continued engagement of sites through activities such as the annual NHS Sustainability Day and tree planting opportunities
- In depth NHS Forest site development via expansion of the Nature Recovery Rangers Programme
- taking part in including green prescribing in the new social movement of social prescribing, tackling the potential for green space to address health inequalities.
For our clinical work, we shall build on the emerging opportunities to:
- Influence ‘future doctors’ via our Sustainable Health Education network’s activities
- Enhance new and existing partnerships to secure Sustainability Fellowships and Scholarships
- Continue to promote The Green Ward Competition programme and extend this into QI programme work
- Look at opportunities that come with the Greener NHS expansion, including supporting NHS Trusts to develop Green Plans
- Build international relationships with key partners that can extend the reach of our work
Our communications officer will help us to develop strong messaging and to design some powerful campaigns which will increase our reach and impact.
Core funding for CSH is being sought from several grant making foundations.
## **Funds held as custodian**
We do not hold any funds as custodian.
## **Members' liability**
The Members of the company guarantee to contribute an amount not exceeding £1 to the assets of the charity in the event of winding up.
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## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **Engagement with employees and employment of the disabled**
Employees have been consulted on issues of concern to them by means of regular consultative committee and staff meetings and have been kept informed on specific matters directly by management. The company carries out exit interviews for all staff leaving the organisation and has adopted a procedure of upward feedback for senior management and the Trustees.
The company has implemented a number of detailed policies in relation to all aspects of personnel matters including:
- Equal opportunities policy
- Volunteers' policy
- Health & safety policy
In accordance with the company's equal opportunities policy, the company has long-established fair employment practices in the recruitment, selection, retention and training of disabled staff.
Full details of these policies are available from the company's offices.
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## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **Engagement with employees and employment of the disabled (continued)**
## **Statement of Trustees' responsibilities**
The Trustees (who are also the directors of the company for the purposes of company law) are responsible for preparing the Trustees' report and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice).
Company law requires the Trustees to prepare financial statements for each financial year. Under company law, the Trustees must not approve the financial statements unless they are satisfied that they give a true and fair view of the state of affairs of the company and of its incoming resources and application of resources, including its income and expenditure, for that period. In preparing these financial statements, the Trustees are required to:
- select suitable accounting policies and then apply them consistently;
- observe the methods and principles of the Charities SORP (FRS 102);
- make judgments and accounting estimates that are reasonable and prudent;
- state whether applicable UK Accounting Standards (FRS 102) have been followed, subject to any material departures disclosed and explained in the financial statements;
- prepare the financial statements on the going concern basis unless it is inappropriate to presume that the company will continue in business.
The Trustees are responsible for keeping adequate accounting records that are sufficient to show and explain the company's transactions and disclose with reasonable accuracy at any time the financial position of the company and enable them to ensure that the financial statements comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the company and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.
Approved by order of the members of the board of Trustees and signed on their behalf by:
## ___________________________
**G Manning** (Acting Chair of Trustees) Date: 08-08-22
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## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED**
**(A company limited by guarantee)**
**INDEPENDENT EXAMINER'S REPORT FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **Independent examiner's report to the Trustees of The Centre for Sustainable Healthcare Limited ('the company')**
I report to the charity Trustees on my examination of the accounts of the company for the year ended 30 November 2021.
## **Responsibilities and basis of report**
As the Trustees of the company (and its directors for the purposes of company law) you are responsible for the preparation of the accounts in accordance with the requirements of the Companies Act 2006 ('the 2006 Act').
Having satisfied myself that the accounts of the company 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 company's accounts carried out under section 145 of the Charities Act 2011 ('the 2011 Act'). In carrying out my examination I have followed the Directions given by the Charity Commission under section 145(5)(b) of the 2011 Act.
## **Independent examiner's statement**
Since the company's gross income exceeded £250,000 your examiner must be a member of a body listed in section 145 of the 2011 Act. I confirm that I am qualified to undertake the examination because I am a member of Association of Certified Chartered Accountants, which is one of the listed bodies.
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:
1. accounting records were not kept in respect of the company as required by section 386 of the 2006 Act; or
2. the accounts do not accord with those records; or
3. the accounts 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
4. the accounts 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 accounts to be reached.
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## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **INDEPENDENT EXAMINER'S REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2021**
This report is made solely to the company's Trustees, as a body, in accordance with Part 4 of the Charities (Accounts and Reports) Regulations 2008. My work has been undertaken so that I might state to the company's Trustees those matters I am required to state to them in an Independent examiner's report and for no other purpose. To the fullest extent permitted by law, I do not accept or assume responsibility to anyone other than the company and the company's Trustees as a body, for my work or for this report.
12-08-22 Signed: Dated: Christina Nawrocki FCCA
## **Wellers**
Independent Examiners 8 King Edward Street Oxford OX1 4HL
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DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED**
## **(A company limited by guarantee)**
## **STATEMENT OF FINANCIAL ACTIVITIES (INCORPORATING INCOME AND EXPENDITURE ACCOUNT) FOR THE YEAR ENDED 30 NOVEMBER 2021**
|**Note**
**Income from:**
Donations and legacies
3
Charitable activities
4
**Total income**
**Expenditure on:**
Charitable activities
5
**Total expenditure**
**Net (expenditure)/income**
Transfers between funds
13
**Net movement in funds**
**Reconciliation of funds:**
Total funds brought forward
Net movement in funds
**Total funds carried forward**|**Restricted**
**funds**
**2021**
**£**
**355,501**
**-**
**355,501**
**383,994**
**383,994**
**(28,493)**
**7,443**
**(21,050)**
**30,287**
**(21,050)**
**9,237**|**Unrestricted**
**funds**
**2021**
**£**
**11,252**
**414,210**
**425,462**
**319,975**
**319,975**
**105,487**
**(7,443)**
**98,044**
**(13,120)**
**98,044**
**84,924**|**Total**
**funds**
**2021**
**£**
**366,753**
**414,210**
**780,963**
**703,969**
**703,969**
**76,994**
**-**
**76,994**
**17,167**
**76,994**
**94,161**|_Total_
_funds_
_2020_
_£_
_203,333_
_195,864_
_399,197_
_400,998_
_400,998_
_(1,801)_
_-_
_(1,801)_
_18,968_
_(1,801)_
_17,167_|
|---|---|---|---|---|
The Statement of financial activities includes all gains and losses recognised in the year.
The notes on pages 21 to 38 form part of these financial statements.
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## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee) REGISTERED NUMBER: 07450026**
## **BALANCE SHEET AS AT 30 NOVEMBER 2021**
|**Note**
**Fixed assets**
Tangible assets
10
**Current assets**
Debtors
11
Cash at bank and in hand
Creditors: amounts falling due within one
year
12
**Net current assets**
**Total assets less current liabilities**
**Net assets excluding pension asset**
**Total net assets**
**Charity funds**
Restricted funds
13
Unrestricted funds
13
**Total funds**|**179,436**
**29,780**
**209,216**
**(119,718)**|**2021**
**£**
**4,664**
**4,664**
**89,498**
**94,162**
**94,162**
**94,162**
**9,237**
**84,925**
**94,162**|_54,038_
_22,490_
_76,528_
_(60,152)_|_2020_
_£_
_791_
_791_
_16,376_
_17,167_
_17,167_
_17,167_
_30,287_
_(13,120)_
_17,167_|
|---|---|---|---|---|
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# **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee) REGISTERED NUMBER: 07450026**
# **BALANCE SHEET (CONTINUED) AS AT 30 NOVEMBER 2021**
The company was entitled to exemption from audit under section 477 of the Companies Act 2006.
The members have not required the company to obtain an audit for the year in question in accordance with section 476 of Companies Act 2006.
The Trustees acknowledge their responsibilities for complying with the requirements of the Act with respect to accounting records and preparation of financial statements.
The financial statements have been prepared in accordance with the provisions applicable to entities subject to the small companies regime.
The financial statements were approved and authorised for issue by the Trustees and signed on their behalf by:
................................................
**G Manning**
(Acting Chair of Trustees) Date: 08-08-22
The notes on pages 21 to 38 form part of these financial statements.
Page 19
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED**
## **(A company limited by guarantee)**
## **STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 30 NOVEMBER 2021**
|**Cash flows from operating activities**
Net cash used in operating activities
**Cash flows from investing activities**
Purchase of tangible fixed assets
**Net cash used in investing activities**
**Cash flows from financing activities**
**Net cash provided by financing activities**
**Change in cash and cash equivalents in the year**
Cash and cash equivalents at the beginning of the year
**Cash and cash equivalents at the end of the year**
The notes on pages 21 to 38 form part of these financial statements|**2021**
**£**
**12,157**
**(4,867)**
**(4,867)**
**-**
**7,290**
**22,490**
**29,780**|_2020_
_£_
_(9,102)_
_(1,199)_
**(1,199)**
**-**
**(10,301)**
_32,791_
_22,490_|
|---|---|---|
Page 20
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
**THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
**NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **1. General information**
The Centre For Sustainable Healthcare Limited is a private company limited by guarantee, incorporated in England and Wales, registration number 07450026. The address of the companies pricipal place of business is Cranbrook House, 287 - 291 Banbury Road, Oxford, Oxfordshire, OX2 7JA.
## **2. Accounting policies**
## **2.1 Basis of preparation of financial statements**
The financial statements have been prepared in accordance with the Charities SORP (FRS 102) - 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 Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) and the Companies Act 2006.
The Centre for Sustainable Healthcare Limited meets the definition of a public benefit entity under FRS 102. Assets and liabilities are initially recognised at historical cost or transaction value unless otherwise stated in the relevant accounting policy.
## **2.2 Going concern**
The charity's operational activities, together with the factors likely to affect its future development, performance and position are set out in the Trustees report on pages 2 to 10.
During the year, the charity made a small loss. Unfortunately, the level of unrestricted income was not sufficient to cover the unrestricted expenditure and as a result, restricted money had been used temporarily to cover ongoing unrestricted expenditure. The Trustees have since sought to secure additional funding in particular unrestricted grants and donations to ensure the unrestricted fund is not overdrawn.
## **2.3 Income**
All income is recognised once the company has entitlement to the income, it is probable that the income will be received and the amount of income receivable can be measured reliably.
Grants are included in the Statement of financial activities on a receivable basis. The balance of income received for specific purposes but not expended during the period is shown in the relevant funds on the Balance sheet. Where income is received in advance of entitlement of receipt, its recognition is deferred and included in creditors as deferred income. Where entitlement occurs before income is received, the income is accrued.
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DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
**THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **2. Accounting policies (continued)**
## **2.4 Expenditure**
Expenditure is recognised once there is a legal or constructive obligation to transfer economic benefit to a third party, it is probable that a transfer of economic benefits will be required in settlement and the amount of the obligation can be measured reliably. Expenditure is classified by activity. The costs of each activity are made up of the total of direct costs and shared costs, including support costs involved in undertaking each activity. Direct costs attributable to a single activity are allocated directly to that activity. Shared costs which contribute to more than one activity and support costs which are not attributable to a single activity are apportioned between those activities on a basis consistent with the use of resources. Central staff costs are allocated on the basis of time spent, and depreciation charges allocated on the portion of the asset’s use.
Expenditure on charitable activities is incurred on directly undertaking the activities which further the company's objectives, as well as any associated support costs.
All expenditure is inclusive of irrecoverable VAT.
## **2.5 Government grants**
Government grants relating to tangible fixed assets are treated as deferred income and released to the Statement of financial activities over the expected useful lives of the assets concerned. Other grants are credited to the Statement of financial activities as the related expenditure is incurred.
## **2.6 Tangible fixed assets and depreciation**
Tangible fixed assets costing £200 or more are capitalised and recognised when future economic benefits are probable and the cost or value of the asset can be measured reliably.
Tangible fixed assets are initially recognised at cost. After recognition, under the cost model, tangible fixed assets are measured at cost less accumulated depreciation and any accumulated impairment losses. All costs incurred to bring a tangible fixed asset into its intended working condition should be included in the measurement of cost.
Depreciation is charged so as to allocate the cost of tangible fixed assets less their residual value over their estimated useful lives, using the straight-line method.
Depreciation is provided on the following basis:
- Computer equipment 33% Straight Line
## **2.7 Debtors**
Trade and other debtors are recognised at the settlement amount after any trade discount offered. Prepayments are valued at the amount prepaid net of any trade discounts due.
## **2.8 Cash at bank and in hand**
Cash at bank and in hand includes cash and short-term highly liquid investments with a short maturity of three months or less from the date of acquisition or opening of the deposit or similar account.
Page 22
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
**THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
**NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **2. Accounting policies (continued)**
## **2.9 Liabilities and provisions**
Liabilities are recognised when there is an obligation at the Balance sheet date as a result of a past event, it is probable that a transfer of economic benefit will be required in settlement, and the amount of the settlement can be estimated reliably.
Liabilities are recognised at the amount that the company anticipates it will pay to settle the debt or the amount it has received as advanced payments for the goods or services it must provide.
Provisions are measured at the best estimate of the amounts required to settle the obligation. Where the effect of the time value of money is material, the provision is based on the present value of those amounts, discounted at the pre-tax discount rate that reflects the risks specific to the liability. The unwinding of the discount is recognised in the Statement of financial activities as a finance cost.
## **2.10 Financial instruments**
The company only has financial assets and financial liabilities of a kind that qualify as basic financial instruments. Basic financial instruments are initially recognised at transaction value and subsequently measured at their settlement value with the exception of bank loans which are subsequently measured at amortised cost using the effective interest method.
## **2.11 Operating leases**
Rentals paid under operating leases are charged to the Statement of financial activities on a straight line basis over the lease term.
## **2.12 Pensions**
The company contributes into a defined contribution pension scheme and the pension charge represents the amounts payable by the company to the fund in respect of the year.
## **2.13 Fund accounting**
General funds are unrestricted funds which are available for use at the discretion of the Trustees in furtherance of the general objectives of the company and which have not been designated for other purposes.
Restricted funds are funds which are to be used in accordance with specific restrictions imposed by donors or which have been raised by the company for particular purposes. The costs of raising and administering such funds are charged against the specific fund. The aim and use of each restricted fund is set out in the notes to the financial statements.
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DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **3. Income from donations and legacies**
|Donations
Grants
Government grants
**Total 2021**
Donations
Grants
Government grants
_Total 2020_|**Restricted**
**funds**
**2021**
**Unrestricted**
**funds**
**2021**
**£**
**£**
1,000
9,331
354,501
-
-
1,921
355,501
11,252
_Restricted_
_funds_
_2020_
_Unrestricted_
_funds_
_2020_
_£_
_£_
_-_
_41,835_
_139,025_
_7,900_
_-_
_14,573_
_139,025_
_64,308_|**Total**
**funds**
**2021**
**£**
**10,331**
**354,501**
**1,921**|
|---|---|---|
|||**366,753**|
|||_Total_
_funds_
_2020_
_£_
_41,835_
_146,925_
_14,573_|
|||_203,333_|
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DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **4. Income from charitable activities**
|**Unrestricted**
**funds**
**2021**
**£**
Income from charitable activities - Clinical
350,262
Income from charitable activities - NHS Forest
63,948
**Total 2021**
414,210
_Unrestricted_
_funds_
_2020_
_£_
Income from charitable activities - Clinical
_119,707_
Income from charitable activities - NHS Forest
_76,157_
_Total 2020_
_195,864_|**Total**
**funds**
**2021**
**£**
**350,262**
**63,948**|
|---|---|
||**414,210**|
||_Total_
_funds_
_2020_
_£_
_119,707_
_76,157_|
||_195,864_|
## **5. Analysis of expenditure on charitable activities**
## **Summary by fund type**
|Clinical
NHS Forest
**Total 2021**|**Restricted**
**funds**
**2021**
**Unrestricted**
**funds**
**2021**
**£**
**£**
50,000
263,989
333,994
55,986
383,994
319,975|**Total**
**funds**
**2021**
**£**
**313,989**
**389,980**|
|---|---|---|
|||**703,969**|
Page 25
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **5. Analysis of expenditure on charitable activities (continued)**
## **Summary by fund type (continued)**
|Clinical
NHS Forest
_Total 2020_|_Restricted_
_funds_
_2020_
_£_
_95,799_
_61,624_
_157,423_|_Unrestricted_
_funds_
_2020_
_£_
_152,647_
_90,928_
_243,575_|_Total_
_funds_
_2020_
_£_
_248,446_
_152,552_|
|---|---|---|---|
||||_400,998_|
## **Summary by expenditure type**
|Clinical
NHS Forest
**Total 2021**
Clinical
NHS Forest
_Total 2020_|**Staff costs**
**2021**
**Depreciation**
**2021**
**£**
**£**
253,448
790
289,598
204
543,046
994
_Staff costs_
_2020_
_£_
_187,243_
_128,922_
_316,165_|**Other costs**
**2021**
**£**
59,751
100,178
159,929
_Other costs_
_2020_
_£_
_61,203_
_23,630_
_84,833_|**Total**
**funds**
**2021**
**£**
**313,989**
**389,980**|
|---|---|---|---|
||||**703,969**|
||||_Total_
_funds_
_2020_
_£_
_248,446_
_152,552_|
||||_400,998_|
Page 26
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **6. Analysis of expenditure by activities**
|Clinical
NHS Forest
**Total 2021**
Clinical
NHS Forest
_Total 2020_
**Analysis of direct costs**|**Activities**
**undertaken**
**directly**
**2021**
**£**
289,008
352,890
641,898
_Activities_
_undertaken_
_directly_
_2020_
_£_
_219,741_
_133,744_
_353,485_|**Support**
**costs**
**2021**
**£**
24,981
37,091
62,072
_Support_
_costs_
_2020_
_£_
_28,704_
_18,809_
_47,513_|**Total**
**funds**
**2021**
**£**
**313,989**
**389,981**|
|---|---|---|---|
||||**703,969**|
||||_Total_
_funds_
_2020_
_£_
_248,445_
_152,553_|
||||_400,998_|
|||||
|Staff costs
Project costs
Project publications, leaflets and maps
Miscellaneous
Conference costs
**Total 2021**|**Clinical**
**2021**
**£**
253,447
34,788
34
690
49
289,008|**NHS Forest**
**2021**
**£**
289,598
58,256
2,134
690
2,212
352,890|**Total**
**funds**
**2021**
**£**
**543,045**
**93,044**
**2,168**
**1,380**
**2,261**|
|---|---|---|---|
||||**641,898**|
Page 27
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **6. Analysis of expenditure by activities (continued)**
## **Analysis of direct costs (continued)**
|Staff costs
Project costs
Project partner costs
Project publications, leaflets and maps
Professional and consultancy
Conference costs
_Total 2020_
**Analysis of support costs**|_Clinical_
_2020_
_£_
_187,243_
_5,031_
_23,320_
_83_
_2,800_
_1,265_
_219,742_|_NHS Forest_
_2020_
_£_
_128,921_
_968_
_75_
_2,399_
_1,000_
_381_
_133,744_|_Total_
_funds_
_2020_
_£_
_316,164_
_5,999_
_23,395_
_2,482_
_3,800_
_1,646_|
|---|---|---|---|
||||_353,486_|
|||||
|Depreciation
Professional and consultancy
Website and computer costs
Travel and subsistence
Printing, postage and stationery
Office expenses
Entertainment
Telephone
Miscellaneous
Bank charges
Rent
Insurance
Payments to charitable parties
Training
Governance costs
**Total 2021**|**Clinical**
**2021**
**£**
790
20
5,115
1,498
66
156
5
319
561
216
6,512
518
1,728
2,899
4,578
24,981|**NHS Forest**
**2021**
**£**
204
20
9,117
3,750
257
142
-
319
1,872
354
12,239
518
155
3,565
4,578
37,090|**Total**
**funds**
**2021**
**£**
**994**
**40**
**14,232**
**5,248**
**323**
**298**
**5**
**638**
**2,433**
**570**
**18,751**
**1,036**
**1,883**
**6,464**
**9,156**|
|---|---|---|---|
||||**62,071**|
Page 28
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **6. Analysis of expenditure by activities (continued)**
## **Analysis of support costs (continued)**
|Professional and consultancy
Website and computer costs
Travel and subsistence
Printing, postage and stationery
Office expenses
Bookkeeping
Entertainment
Telephone
Miscellaneous
Bank charges
Rent
Insurance
Payments to charitable parties
Training
Depreciation
Governance costs
_Total 2020_
**7.**
**Independent examiner's remuneration**|_Clinical_
_2020_
_£_
_20_
_9,508_
_467_
_134_
_29_
_150_
_130_
_643_
_274_
_322_
_10,476_
_325_
_1,437_
_120_
_226_
_4,443_
_28,704_|_NHS Forest_
_2020_
_£_
_20_
_5,941_
_627_
_8_
_78_
_178_
_-_
_647_
_277_
_32_
_6,024_
_-_
_252_
_55_
_226_
_4,443_
_18,808_|_Total_
_funds_
_2020_
_£_
_40_
_15,449_
_1,094_
_142_
_107_
_328_
_130_
_1,290_
_551_
_354_
_16,500_
_325_
_1,689_
_175_
_452_
_8,886_|
|---|---|---|---|
||||_47,512_|
|||||
||**2021**|_2020_|
|---|---|---|
||**£**|_£_|
|Fees payable to the company's independent examiner for the independent|||
|examination of the company's annual accounts|**4,800**|_4,800_|
Page 29
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **8. Staff costs**
|Wages and salaries
Social security costs
Contribution to defined contribution pension schemes|**2021**
**£**
**479,427**
**38,369**
**25,250**
**543,046**|_2020_
_£_
_280,749_
_20,213_
_15,203_|
|---|---|---|
||||
|||_316,165_|
The average number of persons employed by the company during the year was as follows:
|Trustee
Administration|**2021**
**No.**
**1**
**19**
**20**|_2020_
_No._
_1_
_9_|
|---|---|---|
||||
|||_10_|
No employee received remuneration amounting to more than £60,000 in either year.
The total remuneration and benefits received by the key management personel totalled £81,400 (2020 - £69,025)
## **9. Trustees' remuneration and expenses**
During the year, one or more Trustees has been paid remuneration or has received other benefits from an employment with the company. The value of Trustees' remuneration and other benefits was as follows:
|||**2021**|_2020_|
|---|---|---|---|
|||**£**|_£_|
|R Stancliffe|Remuneration|**48,033**|_44,000_|
|During the year ended 30 November 2021,|expenses were reimbursed or paid directly to 1||Trustee_(2020_|
|_- to 1 Trustee)_broken down as follows:||||
|||**2021**|_2020_|
|||**£**|_£_|
|Travel, subsistence and meeting costs||**1,217**|_-_|
Page 30
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
|**10.**
**Tangible fixed assets**
**Cost or valuation**
At 1 December 2020
Additions
At 30 November 2021
**Depreciation**
At 1 December 2020
Charge for the year
At 30 November 2021
**Net book value**
At 30 November 2021
_At 30 November 2020_|**Office**
**equipment**
**£**
**2,965**
**4,867**|
|---|---|
||**7,832**|
||**2,174**
**994**|
||**3,168**|
||**4,664**|
||_791_|
Page 31
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **11. Debtors**
|**Due within one year**
Trade debtors
Other debtors
Prepayments and accrued income
**Creditors: Amounts falling due within one year**
Trade creditors
Other taxation and social security
Other creditors
Accruals and deferred income|**2021**
**£**
**103,444**
**75,219**
**773**
**179,436**
**2021**
**£**
**12,131**
**24,582**
**76,360**
**6,645**
**119,718**|_2020_
_£_
_35,231_
_18,158_
_649_|
|---|---|---|
||||
|||_54,038_|
|||_2020_
_£_
_9,195_
_40,374_
_3,938_
_6,645_|
||||
|||_60,152_|
## **12. Creditors: Amounts falling due within one year**
Page 32
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **13. Statement of funds**
## **Statement of funds - current year**
|**Unrestricted funds**
General Funds
**Restricted funds**
Connecting Q Locally
HF South Warwicksire
SusQi Education
Heathrow Community Fund
Postcode Local Trust
HF Remote consultations
Green Recovery Challenge
**Total of funds**|**Balance at 1**
**December**
**2020**
**£**
**(13,120)**
**8,800**
**-**
**-**
**4,958**
**12,625**
**3,904**
**-**
**30,287**
**17,167**|**Income**
**£**
**425,463**
**-**
**26,927**
**50,000**
**7,433**
**1,000**
**4,732**
**265,409**
**355,501**
**780,964**|**Expenditure**
**£**
**(319,975)**
**(11,832)**
**(17,690)**
**(50,000)**
**(12,391)**
**(13,625)**
**(13,047)**
**(265,409)**
**(383,994)**
**(703,969)**|**Transfers**
**in/out**
**£**
**(7,443)**
**3,032**
**-**
**-**
**-**
**-**
**4,411**
**-**
**7,443**
**-**|**Balance at**
**30**
**November**
**2021**
**£**
**84,925**|
|---|---|---|---|---|---|
||||||**-**
**9,237**
**-**
**-**
**-**
**-**
**-**|
||||||**9,237**|
||||||**94,162**|
Page 33
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **13. Statement of funds (continued)**
## **Statement of funds - prior year**
|**Unrestricted funds**
General Funds
**Restricted funds**
Global Health
Connecting Q Locally
Postcode Local Trust Grant
HF Remote Consultations
Postcode Local Trust Grant
SusQi Education
Health Foundation
Seeing Is Believing
Postcode Local Trust Grant
Heathrow Community Fund
Green Walking Project
Big Lottery - Wood Farm
**Total of funds**|_Balance at_
_1 December_
_2019_
_£_
_(31,381)_
_1,664_
_-_
_-_
_-_
_1,747_
_(195)_
_10,553_
_2,712_
_1,939_
_23,594_
_7,535_
_800_
_50,349_
_18,968_|_Income_
_£_
_260,172_
_-_
_18,000_
_19,500_
_10,000_
_1,625_
_66,701_
_14,545_
_-_
_-_
_8,654_
_-_
_-_
_139,025_
_399,197_|_Expenditure_
_£_
_(243,575)_
_-_
_(9,200)_
_(6,875)_
_(6,096)_
_(5,311)_
_(66,506)_
_(25,098)_
_(2,712)_
_-_
_(27,290)_
_(7,535)_
_(800)_
_(157,423)_
_(400,998)_|_Transfers_
_in/out_
_£_
_1,664_
_(1,664)_
_-_
_-_
_-_
_1,939_
_-_
_-_
_-_
_(1,939)_
_-_
_-_
_-_
_(1,664)_
_-_|_Balance at_
_30_
_November_
_2020_
_£_
_(13,120)_
_-_
_8,800_
_12,625_
_3,904_
_-_
_-_
_-_
_-_
_-_
_4,958_
_-_
_-_
_30,287_
_17,167_|
|---|---|---|---|---|---|
Page 34
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **14. Summary of funds**
## **Summary of funds - current year**
|General funds
Restricted funds|**Balance at 1**
**December**
**2020**
**£**
**(13,120)**
**30,287**
**17,167**
_Balance at_
_1 December_
_2019_
_£_
_(31,381)_
_50,349_
_18,968_|**Income**
**£**
**425,463**
**355,501**
**780,964**
_Income_
_£_
_260,172_
_139,025_
_399,197_|**Expenditure**
**£**
**(319,975)**
**(383,994)**
**(703,969)**
_Expenditure_
_£_
_(243,575)_
_(157,423)_
_(400,998)_|**Transfers**
**in/out**
**£**
**(7,443)**
**7,443**
**-**
_Transfers_
_in/out_
_£_
_1,664_
_(1,664)_
_-_|**Balance at**
**30**
**November**
**2021**
**£**
**84,925**
**9,237**
**94,162**
_Balance at_
_30_
_November_
_2020_
_£_
_(13,120)_
_30,287_
_17,167_|
|---|---|---|---|---|---|
|**Summary of funds - prior year**||||||
|General funds
Restricted funds||||||
## **15. Analysis of net assets between funds**
## **Analysis of net assets between funds - current year**
|Tangible fixed assets
Current assets
Creditors due within one year
**Total**|**Restricted**
**funds**
**2021**
**Unrestricted**
**funds**
**2021**
**£**
**£**
-
4,664
9,237
199,980
-
(119,718)
9,237
84,926|**Total**
**funds**
**2021**
**£**
**4,664**
**209,217**
**(119,718)**
**94,163**|
|---|---|---|
Page 35
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **15. Analysis of net assets between funds (continued)**
## **Analysis of net assets between funds - prior year**
|Tangible fixed assets
Current assets
Creditors due within one year
**Total**|_Restricted_
_funds_
_2020_
_£_
_-_
_30,287_
_-_
_30,287_|_Unrestricted_
_funds_
_2020_
_£_
_791_
_46,241_
_(60,152)_
_(13,120)_|_Total_
_funds_
_2020_
_£_
_791_
_76,528_
_(60,152)_|
|---|---|---|---|
||||_17,167_|
## **16. Reconciliation of net movement in funds to net cash flow from operating activities**
|Net income/expenditure for the year (as per Statement of Financial
Activities)
**Adjustments for:**
Depreciation charges
Increase in debtors
Increase in creditors
**Net cash provided by/(used in) operating activities**|**2021**
**£**
**76,994**
**994**
**(125,399)**
**59,568**
**12,157**|_2020_
_£_
_(1,801)_|
|---|---|---|
|||_452_
_(34,929)_
_27,176_|
||||
|||_(9,102)_|
## **17. Analysis of cash and cash equivalents**
|Cash in hand
**Total cash and cash equivalents**|**2021**
**£**
**29,780**
**29,780**|_2020_
_£_
_22,490_|
|---|---|---|
||||
|||_22,490_|
Page 36
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **18. Analysis of changes in net debt**
|Cash at bank and in hand|**At 1**
**December**
**2020**
**£**
**22,490**
**22,490**|**Cash flows**
**£**
**7,291**
**7,291**|**At 30**
**November**
**2021**
**£**
**29,781**|
|---|---|---|---|
||||**29,781**|
Page 37
DocuSign Envelope ID: FF5A430B-0FBD-4D25-A55F-F0B90C1BE8B6
## **THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)**
## **NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2021**
## **19. Pension commitments**
The company contributes into a defined contributions pension scheme. The assets of the scheme are held separately from those of the company in an independently administered fund. The pension cost charge represents contributions payable by the company to the fund and amounted to £25,250 (2020 - £15,203).
## **20. Operating lease commitments**
At 30 November 2021 the company had commitments to make future minimum lease payments under non-cancellable operating leases as follows:
||||**2021**|_2020_|
|---|---|---|---|---|
||||**£**|_£_|
|Not later than|1|year|**-**|_30,000_|
## **21. Members' liability**
Each member of the charitable company undertakes to contribute to the assets of the company in the event of it being wound up while he/she is a member, or within one year after he/she ceases to be a member, such amount as may be required, not exceeding £1 for the debts and liabilities contracted before he/she ceases to be a member.
Page 38