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2022-11-30-accounts

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

Registered number: 07450026 Charity number: 1143189

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

(A company limited by guarantee)

TRUSTEES' REPORT AND FINANCIAL STATEMENTS

YEAR ENDED 30 NOVEMBER 2022

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

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 - 16
Independent auditors' report on the financial statements 17 - 21
Statement of financial activities 22
Balance sheet 23 - 24
Statement of cash flows 25
Notes to the financial statements 26 - 43

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

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 2022

Trustees R Stancliffe
M Smeeth
G Manning, Acting Chair
J Rhys-Griffith
D Mackay
Dr R Hixson
J Lelliott OBE (appointed 1 January 2021)
Dr M Tomson (appointed 14 June 2022)
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
Independent auditors
Wellers
for and on behalf of
Statutory Auditors
8 King Edward Street
Oxford
OX1 4HL

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DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

TRUSTEES' REPORT FOR THE YEAR ENDED 30 NOVEMBER 2022

The Trustees present their annual report together with the audited financial statements of the The Centre for Sustainable Healthcare Limited for the year 1 December 2021 to 30 November 2022. 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: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2022

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 2022 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 43 volunteers and students on elective placements.

Achievements and performance

a. Review of activities

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 2022, bringing the total to 12, and over 1000 healthcare professionals participated in the small-group training days this year. We also worked further with Health Education England to design 2 more short courses that are available free to everyone in the NHS.

We have supported the first round of Green Plans for Integrated Care Systems, partnered with new specialty areas and expanded our work in Wales. The Sustainable Quality Improvement team has 4 new staff members to help deliver an exciting range of projects in diverse clinical settings.

In the 2021-2022 season we planted 15,721 trees at 83 sites. The 100,000th NHS Forest tree was planted in

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DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2022

Achievements and performance (continued)

December 2022. Completing the project funded at half a million pounds from the Green Recovery Challenge Fund has been a huge amount of work in the Green Space team, with funding secured for a subsequent programme from the Trees Call to Action Fund, which is £150,000 per year over 3 years. We now have 5 Nature Recovery Rangers embedded at hospital sites, working with staff and patients and community to deliver change on the ground. They have made a huge difference to the sites where they have been based and the programme is being requested at other NHS sites.

In October we held a second 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 2022, CSH continued growth in all programmes with 11 new staff:

  1. In the Green Space Programme we employed 6 new staff members including Felicity Harris as Programme Director, Emma Edwards as Ranger Manager and 4 new rangers.

  2. In the Clinical Programme we employed a Clinical Programme Manager, Hazel Walsh, a new Fellow in Quality Improvement, Alice Clack and a Sustainable Practice Lead, Catherine Richards.

  3. For the core team we hired a full-time Admin lead Aneesa Aljahmi, and Sara LeMaitre has joined as a Comms assistant in addition to our full time comms lead.

Green Space Programme in 2021/22

Improving the management and use of NHS land/green space and community access to green space.

Key achievements in 2022 include a major piece of work on strategy:

HEALTHCARE HAPPENS HERE: THE NHS GREEN ESTATE AS A RESILIENT HEALTHCARE ASSET

All too often, our thinking about healthcare and the delivery of health services focuses on spaces within hospital and medical practice buildings, with no consideration of the potential of the outside space also managed by healthcare organisations. We want to change this perspective, demonstrating that “healthcare happens here” – that green spaces on healthcare sites can be a resilient healthcare asset, with benefits to human health and the natural environment. That is why we are working to support the NHS to realise the potential of its green estate as a resilient healthcare asset.

IMPROVING BIODIVERSITY ON NHS GREEN ESTATE

Connecting and improving trees and woodlands

In the 2021-2022 season we planted 15,721 trees at 83 sites. The 100,000th NHS Forest tree was planted in December 2022. We are increasingly seeing NHS Green Plans cite the NHS Forest and tree planting, woodland creation and connectivity as deliverables.

Our NHS Forest ‘Trees Call to Action’ project started in July 2022. This project is funded by the Trees Call to Action Fund. The fund was developed by Defra in partnership with the Forestry Commission and is being delivered by the Heritage Fund. Over the next two years we will be focusing on tree planting and woodland improvement and management as we work with NHS partners in specific areas to maximise the benefits trees and woodlands on NHS estate provide for nature, staff, patients and the wider community.

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DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2022

Achievements and performance (continued)

Other biodiversity improvements

Recognising the importance of accessible, biodiverse-rich space close to hospital buildings we have been developing a number of spaces, transforming them from grey to green; improving biodiversity in existing gardens and grounds and providing opportunities for people to connect with those spaces.

Fazakerley Woods, Liverpool

Fazakerley Woods is adjacent to Aintree University Hospital in Liverpool; at over 13 hectares, it forms a significant area of woodland within an urban setting, surrounded by housing, business estates and a prison. The location of the woodland makes it vulnerable to anti-social behaviour including fly tipping and vandalism, but it also provides huge potential for the area to be used as a community and healthcare asset, providing easily accessible green space for hospital staff, patients, and residents.

Our Nature Recovery Ranger, Nick White, has been working on site with a group of volunteers, the Friends of Bluebell Woods, to carry out remedial works, improve habitat management and increase accessibility. Although still early in the process, Nick is working on longer term plans to renovate the woodlands and develop a sustainable management plan. In addition to making environmental improvements, the aim is to increase usability of the space for a range of groups, for example green social prescribers, respite groups for carers, healthcare staff and the general public.

Increasing NHS staff resilience, health and wellbeing

Our Green Recovery Challenge Fund programme came to an end in June. The resulting Green Space for Health Evaluation report provides a review of the NatureWell outdoor wellbeing sessions carried out in 2021, with 51 staff from five NHS trusts. They reported improved wellbeing, satisfaction and happiness levels, both immediately after the sessions and one month later, and a reduction in anxiety.

“Taking time out to breathe and focus on the trees, even for two minutes has really helped to ease my stress and anxiety.” – NatureWell participant

The report also evaluates the Nature Recovery Ranger pilot project which delivered activities to support NHS staff wellbeing through nature-based interventions. The majority of participants stated that taking part in the activities had increased their understanding of the natural environment, benefitted their wellbeing, and inspired them to protect the environment.

Staff wellbeing through Green Gym, Newcastle

The Newcastle Hospitals Green Gym, in partnership with the Northumberland Rivers Trust, has run monthly events since May 2018, engaging hospital staff, family and friends in various conservation activities. The aim is to improve wellbeing through nature connection, as well as make a positive contribution to the local environment. As a result of the pandemic there was a decline in attendance and the programme needed reinvigoration.

Our Nature Recovery Ranger, Sally Johnson, has recently taken up post, working across the Royal Victoria Infirmary and Freeman Hospital in Newcastle; part of her remit is to improve and expand the Green Gym programme. Sally has increased communication and widened interest; building a programme of events near the hospital, which she is running twice a week throughout winter to keep people motivated to get outdoors and connect with nature through the coldest months.

Staff Meadows Health and Wellbeing Route, Cardiff

At the University Hospital of Wales, we worked to create a walking route between the hospital site and the

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DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2022

Achievements and performance (continued)

biodiverse wildflower meadows at Heath Park. Through the installation of interpretation panels and online resources, the project encourages staff, patients, visitors and the wider community to make use of this space for health and wellbeing. Additional initiatives, such as a staff walking group, are being developed to further support the wellbeing of staff working at the site.

Developing the NHS green estate for healthcare

We know that our knowledge and understanding of the health benefits of green space are increasing all the time. We continue to support people to develop their knowledge and understanding through our education, network and evidence base.

Community Green Hub, Homerton

At Homerton Hospital in Hackney, our Nature Recovery Ranger, Naomi Paine, is working on transforming the hospital into a community green hub, utilising green spaces for health and wellbeing activities and embedding the concept of nature recovery into treatment and preventative care.

For example, Naomi has identified the Diabetes Unit as a key point for community integration; they organise regular walking groups with outpatients and provide education on healthy eating and outdoor activities. With staff and patient input, she is creating an allotment garden and green wellbeing space on publicly accessible land outside their unit, to deliver these goals along with a programme of nature- connection activities. This supports patients, staff, and community groups in using nature-connection to improve their mental and physical health, as well as providing opportunities for preventative care and capitalising on the hospital’s position within the community to make it a welcoming, restorative, educational facility.

Green Space Staff changes

In June 2022 we were sad to say goodbye to Carey Newson who was the Green Space Director, leading an expanded team. She not only delivered the Green Recovery Challenge Fund project during the year but also to secure funding for follow-on projects. We have recruited Felicity Harris as an excellent new Director and we are already benefitting from her experience and strategic insight from decades working in the natural environment sector and a background in secondary school teaching. In addition to a new full time Ranger Manager we have appointed new rangers: Naomi Paine, William Styles, Sally Johnson and Nick White.

Clinical Programme: Highlights in 2021/22

The team continued to grow with a new appointment of a Clinical Programme Manager, Hazel Walsh, a new Fellow in Quality Improvement, Alice Clack, a Network Manager, Susannah McWilliam, and a Sustainable Practice Lead, Catherine Richards. In addition, we continue to provide mentoring and supervision to Fellows and Scholars.

Sustainable Specialties

CSH Specialties work has focused on development of our fellow and scholarship programmes during the period December 2021-November 2022. There has been a significant increase in the number of scholar and fellowship programmes at CSH, from four in December 2021 and rising to a peak of 32 in October 2022. The programme is supported by Clinical Specialties Lead, Catherine Floyd.

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THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2022

Achievements and performance (continued)

Fellowships

All of the four fellowships which started in September 2021 (Anaesthetics, Endoscopy, Education and a Welsh Clinical Leadership Fellow) have continued during 2022. Three of these fellows remained employed in their health board/trust and worked half time alongside their clinical duties. The Education Fellow (initially Victoria Stanford, who was replaced by Alice Clack in August 2022) worked full time, or 0.9WTE respectively, for CSH.

Examples of outputs made possible by the fellows, included:

• publication of the Position Statement on Reducing the environmental footprint of gastrointestinal endoscopy:

European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA)

Five other new Fellows started in August 2022, all remaining with their current employers and seconded to CSH. Specialties covered include Paediatrics, Oncology, Anaesthetics/ICU, Dental Clinical Leadership and Valuebased Health Care. Each fellowship lasts 12 months, apart from the value-based healthcare fellow, which was a 7 month programme.

Scholarships

Two new individual scholarship programmes started in March 2022, with scholars from backgrounds in child health and ophthalmology. Individual scholar programmes last 12 months. They also remain with their current employer, but in contrast to the fellows, scholars have only up to one day per week to devote to sustainable healthcare work.

21 scholars joined one of our three group scholar programmes, whist still remaining with their existing employer. Two of these covered geographical areas (Cardiff and Vale and Cwm Taf Morgannwg University Health Boards) and one covered a specialty, Kidney Care, alongside the national kidney care professional and patient organisation, UK Kidney Care Association.

This year’s scholarship programmes have included sustainable quality improvement projects in ENT surgery (reducing the need for general anaesthetic for patients undergoing nasal surgery) and reduction in the inappropriate use of inhalers for patients in primary care.

Networks

Our sustainable networks hub (link is external), which serves as a forum for the exchange of ideas on sustainability in clinical specialties, gained a total of 1,014 new members during the year. In addition to this, we launched three new networks, Imaging Susnet, Clinical Labs Susnet, and Orthoptic Susnet bringing the total number of networks to 28.

Throughout the year, we have also been hard at work designing and building a revamped and improved networks platform that will maximise sector engagement and drive sustainable change. Susannah, our Network Hub Coordinator, led this initiative, in addition to expanding and managing the current networks platform and nurturing their communities of practice. Susannah left us in October to take up a more local employment in Wales, and we started recruiting her successor (who started in early 2023).

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THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2022

Achievements and performance (continued)

Sustainable Clinical Practice

The CSH Green Team Competition is an award-winning leadership and engagement programme to transform healthcare by cutting carbon, improving patient care & staff experience and saving money. CSH ran 7 competitions in 2022 with 35 teams from a range of specialties and departments. Teams identified, developed, and measured the outcomes of 'SusQI' projects that were implemented in real healthcare settings in England and Wales, demonstrating how sustainability is part and parcel of quality improvement across the NHS.

Teams were supported to consider the impact of their projects across the triple bottom line of sustainable value including carbon footprinting their projects. Together, the teams achieved potential annual savings of £783,564 and 7,196,266 kgCO2e, equivalent to driving over 20.7 million miles in an average car. Teams have also improved patient care as well as patient and staff experience through their work.

Joanne Woolley, Audit and Improvement Manager at The Christie NHS Foundation Trust said: “It has been exciting having the Green Team Competition running in our trust. We weren’t sure in advance what the project outcomes would be as the timescale is challenging for busy staff. The CSH team supported the teams incredibly well and really challenged them to think broadly about the improvements they might investigate. The Awards Ceremony was an uplifting event particularly as the impact was so impressive across all the projects for patients and for staff. It is clear that our teams are really motivated to continue the work they have started. We look forward to taking the learning forward.”

Sustainability in QI Education

In 2022, the SusQI Education project, generously funded by Health Education England, The Health Foundation, and King's College London, successfully recruited 14 beacon sites across the UK, representing a diverse range of specialties and education levels. These sites included undergraduate and postgraduate education in medicine, nursing, midwifery, and allied health professions training.

Key achievements for the SusQI Education Project in 2022 include:

  1. Building on the lessons learnt in 2021, each site identified key educators to become SusQI Leads. This was designed to ensure SusQI education continued at the beacon sites even after the project ended. The key educators received training in delivering SusQI education by attending the newly launched CSH Teaching SusQI course. The CSH SusQI team mentored the beacon site SusQI leads to enable them to embed sustainability and the SusQI framework into current QI teaching materials and assessment. Training and Mentorship of SusQI Leads: Each beacon site identified key educators to become SusQI Leads, ensuring the sustainability and growth of SusQI education. These educators received training through the CSH Teaching SusQI course and ongoing mentorship from the CSH SusQI team.

  2. Comprehensive Open-Access Educator Pack: A new educator pack was launched on the SusQI website, providing essential resources for SusQI education delivery, including lesson plans, preparatory materials, workshop slide decks, group activities, facilitator guides, and assessment criteria guidance.

A new open access educator pack was launched and made available for download on the SusQI website. This is a comprehensive educator pack including lesson plans, preparatory material, a 3hr workshop slide deck with speaker notes, group activities with accompanying facilitator guides and assessment criteria guidance.

  1. Positive Student Feedback and Publication: Multi-centre and multi-professional student feedback data was analysed and the results were published in Medical Teacher, May 2022. The findings were overwhelmingly positive and demonstrated that SusQI education had a transformational impact on students. Students developed a ‘sustainable’ lens, and SusQI education was proved to increase motivation to do Quality Improvement in itself and provided. Findings also showed that SusQI education inspired hope and it gave students‘ concrete ways to

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THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2022

Achievements and performance (continued)

make a difference’.

  1. The findings were disseminated at various conferences including Royal College of Nursing Education Conference, SHARE conference and AMEE conference. Conference Presentations: The SusQI Education project findings were disseminated at prominent conferences, including the Royal College of Nursing Education Conference, SHARE Conference, and AMEE Conference.

  2. Evaluation data was collected from the key educators who had been trained as SusQI Leads. Surveys and semi-structured interviews were conducted. The data from the educator's perspective are currently being analysed with the aim to publish the results in 2023. Evaluation Data and Future Publication: Evaluation data was collected from trained SusQI Leads through surveys and semi-structured interviews. Data analysis is currently underway, with the aim of publishing the results in 2023.

  3. In August 2022, the SusQI Education Project moved into an intensive ‘spread’ phase; at the same time, grant funding of the project came to an end. The team developed a strategy for encouraging spread through an expansion of the Beacon Site Programme, open to both academic institutions and healthcare delivery organisations offering ‘Aspiring’ and ‘Established’ Beacon Site Recognition. Sites can receive recognition for embedding sustainability into education and practice upon submission of evidence to CSH (together with a small administration fee). In addition, CSH launched enhanced support packages to SusQI Leads through the new SusQI Academy, which provides training, mentoring, strategic input and networking. This is planned to increase impact of the programme and also to provide a steady income stream to support this strand of work.

Education

In 2022, CSH continued to develop and expand its range of educational initiatives, training health professionals and organisations in sustainable healthcare and planetary health.

Key achievements for the Education Programme in 2022 include:

  1. Online Short Courses: CSH added three new specialty courses, Sustainable Kidney Care, Sustainable Respiratory Care, and Sustainable Anaesthetics, bringing our suite of courses to 12. This year our foundation courses were attended by 375 people and our technical courses (SusQI, Teaching SusQI and Carbon Footprinting) by 404 people. A total of 1630 clinicians, managers and researchers have now completed our courses since we first launched in June 2020 and return for ongoing mentoring in Sustainable Healthcare cafés. In 2022 participants booked onto to courses from 20 different countries. Feedback continues to be universally positive:

“Comprehensive, stimulating and thought-provoking “ - Dr Ahmad Tarakji, Consultant Nephrologist

“The pre-reading was brilliant. It was also great to meet like-minded people and make connections.” - Tessa Dadge, Neurophysiotherapist, Wales

  1. Board-Level Workshops: In response to requests from Trusts and ICSs, CSH launched a bespoke workshop on net zero leadership for executives. Involving a brief pre-reading of materials and two-hour workshop tailored to the local context and Green Plan, it identifies strategies to inspire staff, accelerate and measure change and highlights what is unique about leadership for sustainability. A follow-up mentoring session is included. This year the team conducted 9 workshops for various Trusts and Health Boards, providing tailored workshops and followup mentoring and are beginning to work regionally with ICBs. The Board Level Training sessions have already been attended by 134 health system executives from the UK and Australia. Next year, it will be rolled out across three regions in England.

  2. Free online modules: CSH and Health Education England Northeast Faculty of Sustainable Healthcare

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THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2022

Achievements and performance (continued)

partnered for a third year to create a free e-learning module for clinicians on Health Education England’s e- Learning for Healthcare platform. ‘Building a Net Zero NHS' (2020) has been attended by nearly 50,000 people, and was made mandatory training by one NHS Trust. ‘Sustainability in Quality Improvement' was launched in 2021, and we have been commissioned to develop ‘Sustainable Dentistry’ for 2023.

  1. Placements in Sustainable Health: We continue to receive applications from clinicians and students who want to learn more about sustainable healthcare by volunteering or interning with us. This year, 43 volunteers and students worked with us on a variety of projects, establishing their expertise in sustainable healthcare and contributing 573 days, or the equivalent of 2 FTE staff to our work.

  2. Consultation and Collaboration: CSH worked with educational bodies to embed sustainability in undergraduate and postgraduate training across various healthcare professions. We are working with various educational bodies to embed sustainability into medicine, nursing and the allied health professions undergraduate and postgraduate training. This year includes an MSc module ‘Sustainable Healthcare’ for Trinity College Dublin, the Royal College of GPs Practice Advisor training, the Royal College of Nursing ‘Leading Sustainability in Health and Social Care’, and Florence Nightingale Foundation’s Green Healthcare Leadership Programme for the independent healthcare sector.

Carbon Modelling

In 2022, the carbon modelling team provided crucial support for various CSH projects, including the Green Ward Competition, Sustainable Scholar and Fellowship Programme, and the Carbon Footprinting Course. The team also contributed to the development of Green Plans for three Integrated Care Systems (ICSs), assisting organisations in reaching their net-zero goals.

Key Carbon Modelling achievements in 2022 include:

  1. Supporting NHS Organisations: CSH partnered with South East London (SEL) ICS, Greener Practice and SeeSustainability to develop the SEL ICS Green Plan. This involved estimating the carbon footprint of SEL’s Integrated Care Board (ICB) and all of the ICS’s General Practices and also developing a standalone Green Plan for Primary Care. CSH also supported Gloucestershire Health and Care NHS Foundation Trust in estimating its baseline carbon footprint. This will help the organisation in monitoring the impact of its carbon reduction initiatives and its progress towards net zero.

  2. Sustainability as part of Accreditation: CSH collaborated with the Royal College of Veterinary Surgeons (RCVS) to develop an environmental sustainability module for its Practice Standards Scheme. The module, with its 1 core standard requirement, 8 GP level requirements and 31 award requirements, will support veterinary practices to monitor and reduce their environmental impact. The new module was launched in August 2022. The assessment of the environmental sustainability Award will start in January, while Core and GP level assessment will start in June 2023.

  3. Discharge to Assess: CSH, in partnership with South Warwickshire healthcare providers, is concluding its evaluation of the impact of Covid-19 changes to the Discharge to Assess process on work patterns, travel, resource use, and clinical and social outcomes. In collaboration with a Master's student from Keele University, a focus group discussion was conducted to assess the social impact on staff. This report is scheduled for publication in 2023.

  4. Digital Transformation: CSH collaborated with Ufonia, an AI company specialising in automating routine telephone conversations, to evaluate the potential financial, environmental, and social impact of using automated conversations for head and neck cancer triage compared to traditional outpatient appointments. The project has moved into the pilot phase, testing the technology in a clinical setting.

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DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2022

Achievements and performance (continued)

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 £1,252,860.

The six main sources of income for this period were: The Green Recovery Challenge Fund, Tree Call to Action Fund, South East London Integrated Care System, Health Education England, The Health Foundation and Cwm Taf Morgannwg University Health Board.

Additional smaller pots of money were secured from: delegate fees for training workshops/ conferences, King’s College Hospital NHS Foundation Trust, Royal College of Veterinary Surgeons, Cardiff and the Vale Health Board, Acute Trusts, Association of Anaesthetists, Thea Pharmaceuticals, Ufonia and Tree Sponsorship for the NHS Forest.

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.

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 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 2022 our monthly operating costs were £92,000, so we have built up a reserve of 1.5 months during this year.

c. Surplus

This financial year (Dec 2021 – Nov 2022) the charity had an income of £1,218,248 and expenditure of £1,106,118 resulting in an operating surplus for the year amounting to £112,130 which has gone to build our reserve.

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THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2022

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 2022

Structure, governance and management

a. Constitution

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) lead by the chair. 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. Trustees are also invited to attend staff away days, relevant training days and other events such as courses and conferences.

Two of our Trustees (Mike Tomson and Gill Manning) have attended specific external Trustees training and have fed back to the whole group.

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.

Page 13

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2022

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. All major projects have a separate risk assessment and risk register. In addition, an overview system of assessing risks is being 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 by the management and the trustees, and the overall risk profile of the company is reviewed annually.

Plans for future periods

Future developments

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.

For our green space programme, the activities planned for 2023 have continued to focus on larger scale more strategic projects. We will continue to prioritise:

For our clinical work, we will build on the emerging opportunities to:

Our communications officers will continue to help us to develop strong messaging and to design powerful campaigns which will increase our reach and impact. We will review the need for more comms capacity during the next year.

We are also planning to hire a Chief Operating Officer during 2023 to take on some of the management and HR tasks from the Director, to allow her to focus on strategic work including external partnerships.

In addition to specific programme funding, core funding for CSH is being sought from several grant making foundations.

Page 14

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

(A company limited by guarantee)

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2022

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.

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:

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.

Page 15

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 30 NOVEMBER 2022

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:

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.

Disclosure of information to auditors

Each of the persons who are Trustees at the time when this Trustees' report is approved has confirmed that:

Auditors

The auditors, Wellers, have indicated their willingness to continue in office. The designated Trustees will propose a motion reappointing the auditors at a meeting of the Trustees.

Approved by order of the members of the board of Trustees and signed on their behalf by:

G Manning (Acting Chair of Trustees) Date: 27-07-23

Page 16

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

INDEPENDENT AUDITORS' REPORT TO THE MEMBERS OF THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

Opinion

We have audited the financial statements of The Centre for Sustainable Healthcare Limited (the 'charitable company') for the year ended 30 November 2022 which comprise the Statement of financial activities, the Balance sheet, the Statement of cash flows and the related notes, including a summary of significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including Financial Reporting Standard 102 'The Financial Reporting Standard applicable in the UK and Republic of Ireland' (United Kingdom Generally Accepted Accounting Practice).

In our opinion the financial statements:

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditors' responsibilities for the audit of the financial statements section of our report. We are independent of the charitable company in accordance with the ethical requirements that are relevant to our audit of the financial statements in the United Kingdom, including the Financial Reporting Council's Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Conclusions relating to going concern

In auditing the financial statements, we have concluded that the Trustees' use of the going concern basis of accounting in the preparation of the financial statements is appropriate.

Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the charitable company's ability to continue as a going concern for a period of at least twelve months from when the financial statements are authorised for issue.

Our responsibilities and the responsibilities of the Trustees with respect to going concern are described in the relevant sections of this report.

Page 17

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

INDEPENDENT AUDITORS' REPORT TO THE MEMBERS OF THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (CONTINUED)

Other information

The other information comprises the information included in the Annual report other than the financial statements and our Auditors' report thereon. The Trustees are responsible for the other information contained within the Annual report. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon. Our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of the audit, or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact.

We have nothing to report in this regard.

Opinion on other matters prescribed by the Companies Act 2006

In our opinion, based on the work undertaken in the course of the audit:

Matters on which we are required to report by exception

In the light of our knowledge and understanding of the charitable company and its environment obtained in the course of the audit, we have not identified material misstatements in the Trustees' report.

We have nothing to report in respect of the following matters in relation to which Companies Act 2006 requires us to report to you if, in our opinion:

Page 18

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

(A company limited by guarantee)

INDEPENDENT AUDITORS' REPORT TO THE MEMBERS OF THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (CONTINUED)

Responsibilities of trustees

As explained more fully in the Trustees' responsibilities statement, the Trustees (who are also the directors of the charitable company for the purposes of company law) are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view, and for such internal control as the Trustees determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.

In preparing the financial statements, the Trustees are responsible for assessing the charitable company's ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the Trustees either intend to liquidate the charitable company or to cease operations, or have no realistic alternative but to do so.

Page 19

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

INDEPENDENT AUDITORS' REPORT TO THE MEMBERS OF THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (CONTINUED)

Auditors' responsibilities for the audit of the financial statements

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an Auditors' report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.

Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities, outlined above, to detect material misstatements in respect of irregularities, including fraud. The extent to which our procedures are capable of detecting irregularities, including fraud is detailed below:

Discussions were held with, and enquiries made of, management and those charged with governance with a view to identifying those laws and regulations that could be expected to have a material impact on the financial statements. During the engagement team briefing, the outcomes of these discussions and enquiries were shared with the team, as well as consideration as to where and how fraud may occur in the entity. The following laws and regulations were identified as being of significance to the entity:

Those laws and regulations considered to have a direct effect on the financial statements include UK financial reporting standards, Company Law, Tax and Pensions legislation, health and safety and employment law.

Audit procedures undertaken in response to the potential risks relating to irregularities (which include fraud and non-compliance with laws and regulations) comprised of: inquiries of management and those charged with governance as to whether the entity complies with such laws and regulations; enquiries with the same concerning any actual or potential litigation or claims; inspection of relevant legal correspondence; review of board minutes; testing the appropriateness of entries in the nominal ledger, including journal entries; reviewing transactions around the end of the reporting period; and the performance of analytical procedures to identify unexpected movements in account balances which may be indicative of fraud.

No instances of material non-compliance were identified. However, the likelihood of detecting irregularities, including fraud, is limited by the inherent difficulty in detecting irregularities, the effectiveness of the entity’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud might be inherently more difficult to detect than irregularities that result from error. As explained above, there is an unavoidable risk that material misstatements may not be detected, even though the audit has been planned and performed in accordance with ISAs (UK).

A further description of our responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website at: www.frc.org.uk/auditorsresponsibilities. This description forms part of our Auditors' report.

Other matters

The prior year figures have not been subject to audit. An independent examination was undertaken on the prior year figures and some work was undertaken on opening balances to give additional audit comfort.

Page 20

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

INDEPENDENT AUDITORS' REPORT TO THE MEMBERS OF THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (CONTINUED)

Use of our report

This report is made solely to the charitable company's members, as a body, in accordance with Chapter 3 of Part 16 of the Companies Act 2006. Our audit work has been undertaken so that we might state to the charitable company's members those matters we are required to state to them in an Auditors' report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the charitable company and its members, as a body, for our audit work, for this report, or for the opinions we have formed.

Christina Nawrocki (Senior statutory auditor)

for and on behalf of

Wellers

Accountants Statutory Auditors 8 King Edward Street Oxford OX1 4HL

08-08-23 Date:

Page 21

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

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 2022

Note
Income from:
Donations and legacies
3
Charitable activities
4
Total income
Expenditure on:
Charitable activities
5
Total expenditure
Net movement in funds
Reconciliation of funds:
Total funds brought forward
Net movement in funds
Total funds carried forward		 Restricted
funds
2022
£
311,706
20,000
331,706
353,961
353,961
(22,255)
9,237
(22,255)
(13,018)		 Unrestricted
funds
2022
£
99,807
786,735
886,542
752,157
752,157
134,385
84,924
134,385
219,309		 Total
funds
2022
£
411,513
806,735
1,218,248
1,106,118
1,106,118
112,130
94,161
112,130
206,291		 Total
funds
2021
£
366,753
414,210
780,963
703,969
703,969
76,994
17,167
76,994
94,161

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

The notes on pages 26 to 43 form part of these financial statements.

Page 22

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee) REGISTERED NUMBER: 07450026

BALANCE SHEET AS AT 30 NOVEMBER 2022

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
Total net assets
Charity funds
Restricted funds
13
Unrestricted funds
13
Total funds		 116,519
297,810
414,329
(217,084)		 2022
£
9,046
9,046
197,245
206,291
206,291
(13,018)
219,309
206,291		 179,435
29,781
209,216
(119,719)		 2021
£
4,664
4,664
89,497
94,161
94,161
9,237
84,924
94,161

Page 23

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

(A company limited by guarantee) REGISTERED NUMBER: 07450026

BALANCE SHEET (CONTINUED) AS AT 30 NOVEMBER 2022

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: 27-07-23

The notes on pages 26 to 43 form part of these financial statements.

Page 24

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

(A company limited by guarantee)

STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 30 NOVEMBER 2022

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 26 to 43 form part of these financial statements		 2022
£
275,528
(7,498)
(7,498)
-
268,030
29,780
297,810		 2021
£
12,157
(4,867)
(4,867)
-
7,290
22,490
29,780

Page 25

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

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.

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.

Page 26

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

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:

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 27

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

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.

Page 28

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

3. Income from donations and legacies

Donations
Grants
Total 2022
Donations
Grants
Government grants
Total 2021		 Restricted
funds
2022
Unrestricted
funds
2022
£
£
-
11,244
311,706
88,563
311,706
99,807
Restricted
funds
2021
Unrestricted
funds
2021
£
£
1,000
9,331
354,501
-
-
1,921
355,501
11,252		 Total
funds
2022
£
11,244
400,269
411,513
Total
funds
2021
£
10,331
354,501
1,921
366,753

Page 29

(A company limited by guarantee)

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

4. Income from charitable activities

Income from charitable activities - Clinical
Income from charitable activities - NHS Forest
Total 2022
Income from charitable activities - Clinical
Income from charitable activities - NHS Forest
Total 2021		 Restricted
funds
2022
Unrestricted
funds
2022
£
£
20,000
649,469
-
137,266
20,000
786,735
Unrestricted
funds
2021
£
350,262
63,948
414,210		 Total
funds
2022
£
669,469
137,266
806,735
Total
funds
2021
£
350,262
63,948
414,210

5. Analysis of expenditure on charitable activities

Summary by fund type

Clinical
NHS Forest
Total 2022		 Restricted
funds
2022
Unrestricted
funds
2022
£
£
-
608,082
353,961
144,075
353,961
752,157		 Total
2022
£
608,082
498,036
1,106,118

Page 30

(A company limited by guarantee)

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

5. Analysis of expenditure on charitable activities (continued)

Summary by fund type (continued)

Clinical
NHS Forest
Total 2021		 Restricted
funds
2021
£
50,000
333,994
383,994		 Unrestricted
funds
2021
£
263,989
55,986
319,975		 Total
2021
£
313,989
389,980
703,969

Summary by expenditure type

Clinical
NHS Forest
Total 2022
Clinical
NHS Forest
Total 2021		 Staff costs
2022
£
459,818
347,427
807,245
Staff costs
2021
£
253,448
289,598
543,046		 Depreciatio
n
2022
Other costs
2022
£
£
2,058
146,206
1,058
149,551
3,116
295,757
Depreciation
2021
Other costs
2021
£
£
790
59,751
204
100,178
994
159,929		 Total
2022
£
608,082
498,037
1,106,118
Total
2021
£
313,989
389,980
703,969

Page 31

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

(A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

6. Analysis of expenditure by activities

Clinical
NHS Forest
Total 2022
Clinical
NHS Forest
Total 2021
Analysis of direct costs		 Activities
undertaken
directly
2022
£
554,951
430,431
985,382
Activities
undertaken
directly
2021
£
289,007
352,891
641,898		 Support
costs
2022
£
53,131
67,606
120,737
Support
costs
2021
£
24,981
37,091
62,072		 Total
funds
2022
£
608,082
498,037
1,106,118
Total
funds
2021
£
313,988
389,982
703,969
Staff costs
Project costs
Miscellaneous
Conference costs
Total 2022		 Clinical
2022
£
459,819
91,696
870
2,566
554,951		 NHS Forest
2022
£
347,426
82,135
870
-
430,431		 Total
funds
2022
£
807,245
173,831
1,740
2,566
985,382

Page 32

(A company limited by guarantee)

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

6. Analysis of expenditure by activities (continued)

Analysis of direct costs (continued)

Staff costs
Project costs
Project publications, leaflets and maps
Miscellaneous
Conference costs
Total 2021
Analysis of support costs		 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
Depreciation
Professional and consultancy
Website and network costs
Travel and subsistence
Printing, postage and stationery
Office expenses
Entertainment
Telephone
Miscellaneous
Repairs and maintenance
Bank charges
Rent
Insurance
Payments to charitable parties
Training
Governance costs
Total 2022		 Clinical
2022
£
2,058
20
25,080
2,806
17
-
1,211
381
1,535
346
533
7,635
1,274
1,418
2,796
6,021
53,131		 NHS Forest
2022
£
1,058
20
44,851
5,857
20
36
1,329
382
4,552
346
388
1,515
(57)
129
1,160
6,020
67,606		 Total
funds
2022
£
3,116
40
69,931
8,663
37
36
2,540
763
6,087
692
921
9,150
1,217
1,547
3,956
12,041
120,737

Page 33

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

(A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

6. Analysis of expenditure by activities (continued)

Analysis of support costs (continued)

Depreciation
Professional and consultancy
Website and network 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

7.

Auditors' remuneration

2022 2021
£ £
Fees payable to the company's auditor for the audit of the company's
annual accounts 5,300 -
Fees payable to the company's auditor in respect of:
Independent examination of the company's annual accounts - 5,230
All non-audit services not included above 8,156 3,936

Page 34

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

8. Staff costs

Wages and salaries
Social security costs
Contribution to defined contribution pension schemes		 2022
£
702,959
67,582
36,703
807,244		 2021
£
479,427
38,369
25,250
543,046

The average number of persons employed by the company during the year was as follows:

Trustee
Administration		 2022
No.
1
25
26		 2021
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 £94,568 (2021 - £81,400)

9. Trustees' remuneration and expenses

During the year, R Stancliffe, a Trustee has been paid remuneration and has received other benefits from their employment with the company for performing her role as Chief Executive Officer. This has been approved by the Charity Commission. The value of Trustees' remuneration and other benefits was as follows:

2022 2021
£ £
R Stancliffe Remuneration 52,245 50,915
During the year ended 30 November 2022, expenses were reimbursed or paid directly to 1 Trustee_(2021_
_- to 1 Trustee)_broken down as follows:
2022 2021
£ £
Travel, subsistence and meeting costs 2,423 -

Page 35

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

10.
Tangible fixed assets
Cost or valuation
At 1 December 2021
Additions
At 30 November 2022
Depreciation
At 1 December 2021
Charge for the year
At 30 November 2022
Net book value
At 30 November 2022
At 30 November 2021		 Office
equipment
£
7,832
7,498
15,330
3,168
3,116
6,284
9,046
4,664

Page 36

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

11. Debtors

Due within one year
Trade debtors
Other debtors
Prepayments and accrued income		 2022
£
115,632
-
887
116,519		 2021
£
103,443
75,219
773
179,435

12. Creditors: Amounts falling due within one year

Trade creditors
Other taxation and social security
Other creditors
Accruals and deferred income
Deferred income at 1 December 2021
Resources deferred during the year
Amounts released from previous periods		 2022
£
14,633
42,647
889
158,915
217,084
2022
£
68,536
234,232
(149,153)
153,615		 2021
£
12,131
24,582
7,825
75,181
119,719
2021
£
-
68,536
-
68,536

Income is deferred as money was received in advance to cover costs which related to the following accounting period.

Page 37

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

13. Statement of funds

Statement of funds - current year

Unrestricted funds
General Funds
Restricted funds
Connecting Q Locally
HF South Warwicksire
SBRI
SusQi Education
Heathrow Community Fund
Postcode Local Trust
Tree Call To Action
Green Recovery Challenge
Total of funds		 Balance at 1
December
2021
£
84,924
-
9,237
-
-
-
-
-
-
9,237
94,161		 Income
£
886,542
-
2,991
-
-
-
-
48,559
280,156
331,706
1,218,248		 Expenditure
£
(752,157)
-
(12,228)
(8,861)
-
-
-
(52,716)
(280,156)
(353,961)
(1,106,118)		 Transfers
in/out
£
-
-
-
-
-
-
-
-
-
-
-		 Balance at
30
November
2022
£
219,309
-
-
(8,861)
-
-
-
(4,157)
-
(13,018)
206,291

Page 38

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

13. Statement of funds (continued)

Statement of funds - prior year

Unrestricted funds
General Funds
Restricted funds
Connecting Q Locally
HF South Warwicksire
SBRI
SusQi Education
Heathrow Community Fund
Postcode Local Trust
Tree Call To Action
Green Recovery Challenge
Total of funds		 Balance at
1 December
2020
£
(13,121)
8,800
-
-
-
4,958
12,625
3,904
-
30,287
17,166		 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
£
84,924
-
9,237
-
-
-
-
-
-
9,237
94,161

Page 39

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

14. Summary of funds

Summary of funds - current year

General funds
Restricted funds		 Balance at
1 December
2020
£
(13,121)
30,287
17,166		 Balance at 1
December
2021
£
84,924
9,237
94,161
Income
£
425,463
355,501
780,964		 Income
£
886,542
331,706
1,218,248
Expenditure
£
(319,975)
(383,994)
(703,969)		 Expenditure
£
(752,157)
(353,961)
(1,106,118)
Transfers
in/out
£
(7,443)
7,443
-		 Balance at
30
November
2022
£
219,309
(13,018)
206,291
Balance at
30
November
2021
£
84,924
9,237
94,161
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
2022
Unrestricted
funds
2022
£
£
-
9,046
-
414,329
(13,018)
(204,066)
(13,018)
219,309		 Total
funds
2022
£
9,046
414,329
(217,084)
206,291

Page 40

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

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
2021
£
-
9,237
-
9,237		 Unrestricted
funds
2021
£
4,664
199,979
(119,719)
84,924		 Total
funds
2021
£
4,664
209,216
(119,719)
94,161

16. Reconciliation of net movement in funds to net cash flow from operating activities

Net income for the year (as per Statement of Financial Activities)
Adjustments for:
Depreciation charges
Decrease/(increase) in debtors
Increase in creditors
Net cash provided by operating activities
17.
Analysis of cash and cash equivalents
Cash in hand
Total cash and cash equivalents		 2022
£
112,130
3,116
62,917
97,365
275,528
2022
£
297,810
297,810		 2021
£
76,994
994
(125,399)
59,568
12,157
2021
£
29,780
29,780

Page 41

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

18. Analysis of changes in net debt

Cash at bank and in hand At 1
December
2021
£
29,781
29,781		 Cash flows
£
268,029
268,029		 At 30
November
2022
£
297,810
297,810

Page 42

DocuSign Envelope ID: 0F6B20D5-1665-4A37-8F05-4FCA754F3DCD

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED (A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 NOVEMBER 2022

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 £36,703 (2021 - £22,919).

20. Operating lease commitments

At 30 November 2022 the company had commitments to make future minimum lease payments under non-cancellable operating leases as follows:

2022 2021
£ £
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 43