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2023-12-31-accounts

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

Registered number: 07450026 Charity number: 1143189

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

(A company limited by guarantee)

TRUSTEES' REPORT AND FINANCIAL STATEMENTS

PERIOD ENDED 31 DECEMBER 2023

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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 - 17
Independent auditors' report on the financial statements 18 - 22
Statement of financial activities 23
Balance sheet 24 - 25
Statement of cash flows 26
Notes to the financial statements 27 - 44

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

REFERENCE AND ADMINISTRATIVE DETAILS OF THE COMPANY, ITS TRUSTEES AND ADVISERS FOR THE PERIOD ENDED 31 DECEMBER 2023

Trustees Gill Manning, Chair
Rachel Stancliffe
Michael Smeeth
Jessica Rhys-Griffith (resigned 17 May 2023, reappointed 12 September 2023)
Duncan Mackay
John Lelliott OBE (resigned 13 June 2023)
Dr Mike Tomson
Company registered
number
07450026
Charity registered
number
1143189
Registered office
8 King Edward Street
Oxford
Oxfordshire
OX1 4HL
Principal operating
office
No physical office
Mailbox address:
Suite 310, 266 Banbury Road
Summertown
Oxford
OX2 7DL
Company secretary
Ingeborg Steinbach
Chief executive officer
R Stancliffe
Independent auditors
Wellers
Statutory Auditors
8 King Edward Street
Oxford
OX1 4HL
Website
https://sustainablehealthcare.org.uk

Page 1

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT FOR THE PERIOD ENDED 31 DECEMBER 2023

The Trustees present their annual report together with the audited financial statements of the company for the period 1 December 2022 to 31 December 2023. 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).

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 and other healthcare organisations to reduce its carbon footprint.

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Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

Objectives and activities (continued)

c. Activities undertaken to achieve objectives

The activities undertaken to achieve these objectives are:

  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 and other healthcare organisation’s to make the links between health and the environment through the NHS Forest and other green space 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 2023 we continued 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 96 volunteers and students on elective placements with a total of 2.4 FTE across the year.

Achievements and performance

a. Review of activities

CSH has had an extremely busy year in 2023 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 2 new courses during 2023, bringing the total to 14, and over 1000 healthcare professionals participated in the small-group training days. We also worked further with Health Education England to design another short course that is available free to everyone in the NHS.

We have partnered with new specialty areas for our clinical programme and expanded our work into Europe with a major role in a new 4 year Horizon funded project which builds on our work in Kidney care. The Sustainable Quality Improvement team has helped deliver an exciting range of projects in diverse clinical settings and in 2023 we launched the SusQI Academy.

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Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

Achievements and performance (continued)

The 100,000th NHS Forest tree was planted in December 2022. There has been a huge amount of work in the Green Space team, with delivery of the existing Trees Call to Action Fund and being successful in a project funded by Defra and the Forestry Commission for planting up to 150,000 trees over the planting seasons of 2023-2025.

In October 2023 we held a third online NHS Forest Conference, with the theme of ‘Trees and woodland as a healthcare asset', attracting 600 delegates, including healthcare staff, outdoor space charities, researchers and artists.

Staffing changes

In 2023, CSH continued growth in all programmes, and now has a total of 29 staff. In the Green Space Programme we had 3 members of staff leave and employed 6 new staff members including Sarah Jordan as Programme Director. In the Clinical Programme we employed Sayed Hussain as an admin for the clinical team, Rachael Ward as the new Networks Manager and a new Fellow in Quality Improvement, Ayoma Ratnappuli. For the core team we hired a full-time communications manager, Michael Huxley, and appointed Helen Sullivan as our first COO, scheduled to start in January 2024.

Green Space Programme in 2022/23

Green Space for Health – improving the management and use of NHS land, green space and access to green space

A healthy local natural environment is a key part of sustainable healthcare. It contributes to the prevention of illness by increasing physical and mental wellbeing and offers therapeutic benefits for recovery. Our annual NHS Forest conference focused on the benefits of trees and woodlands, demonstrating how they are a valuable healthcare asset that should not be taken for granted. NHS sites need to have a biodiversity plan in place by January 2024, and our work in 2023 has been supporting sites to achieve this goal.

Throughout 2023, we have been working to improve biodiversity on the NHS estate, as well as connecting staff, patients and the wider community with green spaces to improve health and wellbeing, recovery and treatment.

We welcomed several new team members to the green spaces team in 2023: Hattie White and Neil Ingram who are working on the NHS Forest Defra funded project; Una Devlin and Daniel Loveard as our Green Spaces comms lead and project lead; and Sarah Jordan as our new Green Space for Health Director. We are delighted to have secured funding to extend our two ranger posts at Mount Vernon and Liverpool, with Billy Styles and Nick White as our Nature Recovery Rangers on these sites.

Improving biodiversity on the NHS estate

In the 2022-2023 season, we planted 9,659 trees at 43 NHS sites, planting hedgerows and memorial trees, as well as restoring and creating woodlands. During this season, in December 2022, the NHS Forest planted its 100,000th tree! We are grateful for the support of our corporate and individual donors, and the Trees Call to Action Fund for enabling this work to happen.

Over the next two years we will be more than doubling this milestone, as we have secured funding from Defra to plant up to a further 150,000 trees on NHS land, working with the Forestry Commission. We are delighted to have welcomed two new team members to deliver this exciting project – Harriet White and Neil Ingram.

This Defra funded project is not just about getting trees in the ground, but also providing NHS sites with advice, support and guidance on planting their trees and maintaining them in the years to come. We are also

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Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

Achievements and performance (continued)

coordinating strategic partnerships to facilitate tree planting, provide support and engage the local community. This project aims to demonstrate the power of trees in creating healthier environments, making healthcare sites places where people can go to be healthy in community. The Defra funding will run alongside our Trees Call to Action funding until March 2025.

In 2023, we have taken a more strategic approach to tree planting, conducting mapping exercises to identify opportunities to connect trees and woodlands across the NHS estate. We provided ecological advice to 6 NHS sites, supporting them to plan how to make best use of their land for biodiversity. We have also been working to increase the evidence base for the value of trees and woodlands to healthcare institutions in partnership with Forest Research. The report estimated the financial value of trees and woodlands to four NHS sites in England, showing remarkable results.

Tree equity

In 2023, we partnered with the Woodland Trust and American Forests to bring a transformative Tree Equity Score tool to the UK. The tool, originally developed in the US, determines the tree canopy cover needed in urban areas for everyone to experience equitable access to the health, economic and climate benefits provided by trees. The tool will enable decision makers, including those at healthcare sites, to prioritise tree planting efforts where they are needed most.

Using the green estate for health

In October 2023, we held our annual NHS Forest conference, with a focus on trees and woodlands as a healthcare asset. The conference attracted over 600 sign ups, and recordings of the speakers are available on our website. The conference announced our NHS Forest Awards Winners for 2023, for Healthcare sites going above and beyond in promoting biodiversity and connecting people with nature.

As part of the conference, we heard inspiring stories of how green spaces can be used effectively for the benefit of staff, patients, and the wider community, including from one of our Green Recovery Rangers, Nick White, based in Liverpool.

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Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

Achievements and performance (continued)

This year, we were also successful in securing further funding for our ranger post at Mount Vernon Cancer Centre in North London.

In 2023, we also carried out an evaluation of our Nature Recovery Ranger programme. We are using this evaluation to re-design and develop the programme to make sure we have the greatest impact on biodiversity on the NHS estate as possible. The Nature Recovery Rangers are well placed to connect staff and patients to green spaces, and through our programme we want to see them flourish across the country.

We ran our fully booked Green Space for Health training in November 2023 and have plans to update the training to include more information about trees and woodlands ahead of our next training session in February 2024. The training enables NHS staff to learn more about using green spaces for health and wellbeing, while facilitating them to develop projects for their own context.

Several sponsors, including RSK, have also made contributions to the NHS Forest, including tree sponsorship and pro bono support.

Looking forward

In 2024, the green space team will continue to provide free trees to NHS sites across England. In the tree planting season 2024-25 we will include fruit trees and standards in our tree offer, along with the tree bundles we have been offering this year. We will continue to provide support with planning, planting and maintenance, providing resources and linking up partners to ensure our trees have the best chance of survival and maturation to benefit generations to come. We will also be launching our new ranger programme, with the aim of building capacity within NHS sites to recover people with nature, and to recover nature for people.

In order to build our unreserved funding, as well as increase resilience for this team, we are developing a consultancy offer for NHS Trusts around their green space and including biodiversity net gain, a new government requirement. We aim to design and develop this offer during 2024, ready to start building income by 2025.

Clinical Programme: Highlights in 2022/23

The clinical team added an administrator, Sayed Hussain, to help improve the service to our clients and team efficiency. Rachael Ward joined us as the new Network Manager and Ayoma Ratnappuli replaced Alice Clack as Clinical Fellow. In addition, we continued to provide mentoring and supervision to Fellows and Scholars

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Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

Achievements and performance (continued)

throughout 2023.

Sustainable Specialties

2023 saw our large 2022-23 cohort of fellows and scholars complete their projects. Scholarships and fellowships support sustainable transformation in SusQI education, surgery, dentistry, oncology, anaesthesia, endoscopy, kidney care, paediatrics and ophthalmology. These programmes influenced desflurane decommissioning, foundation school curricula and dentistry training, launched a new Women’s Health sustainability network, saw new textbook chapters on sustainability in surgery and general medicine, and contributed to the literature on the carbon footprint of pharmaceuticals.

Welsh scholars at Cwn Taf Morgannwg (CTM) Health Board undertook wide-ranging projects from food waste and repurposing recycling to inhalers.Five kidney scholars supported by the UK Kidney Association worked on projects that reduced waste and saved carbon and money in haemodialysis and peritoneal dialysis, while improving patient and staff experience.

In November, the landmark Green Surgery Report was launched by the UK Health Alliance on Climate Change, CSH and Brighton and Sussex Medical School. The report was endorsed by organisations from across the specialty and provides evidence-based recommendations for sustainable practice in surgical care.

2024 will see the start of the exciting European KitNewCare project in kidney care. CSH is one of the lead partners in a European consortium which will be working with pilot clinical centres to develop sustainable innovations in kidney care and drive their adoption across Europe. As part of our new Sustainable Specialties three year strategy, KitNewCare will generate a tested model for specialty transformation.

Networks

Our sustainable networks hub serves as a forum for the exchange of ideas, questions, tools and resources on sustainability in clinical specialties.

During the first quarter of 2023 we recruited Rachael Ward, the new Networks Manager, and worked hard to complete the build and launch of the new improved networks platform that will maximise sector engagement and drive sustainable change.

Since the new Networks Platform launched in April 2023, we have seen some fantastic growth in our community. The Networks Platform has almost doubled in 2023, with a community of +6200 members worldwide!

We have 1976 topics, 834 resources, including case studies, and 161 events across the platform. 73k of our user instances have come from the UK in 2023, with 2.8k from the US, and 2.2k from Australia. We have had 89k platform views since April and our resource library page has had +10k views.

We plan to step things up next year, with more events, transferable case studies, new partnerships, and engaging content, there is so much to share, celebrate, strengthen, and learn from.

“ CSH networks enabled me to link up with colleagues from different disciplines and NHS Trusts working on a sustainability project that had already been implemented in my Trust. By sharing information on my Trust's project, I was able to help them move forward with theirs and convince their Trust's infection control team that the project was possible”. Emily Parker, Sustainability Fellow in Paediatric Medicine.

The CSH networks are currently funded through CSH's core funding, and we are exploring new income generation opportunities to ensure this important service can be sustained through project funding or new

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Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

Achievements and performance (continued)

sources of core funding.

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 have collaborated with 5 NHS Trusts and an Integrated Care Board (ICB) in England in 2023 to deliver 6 Green Team Competitions. 35 participating teams from a range of specialties and professional groups have developed case studies to share and spread their impacts and learning. 17 of these case studies are available now via our publicly available Resource Library.

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.

Publications:

•Angela Hayes’s point of view on using the Green Team Competition to effect change and help greening the NHS. Her most recent paper for Nursing Times examines the advantages of hosting a Green Team Competition with CSH to drive long-term changes in workplace practices.

• Blog post on Q network. Solving NHS demand challenges with a sustainability lens: SusQI examples from the Green Team Competition. Rachel McLean, the lead for the Green Team Competition, reflects on two sustainability in quality improvement (SusQI) projects from recent Green Team Competitions showing huge potential for improving patient care while saving staff time, saving money and reducing environmental impact.

Events / Competitions / Conferences / Talks:

• BMJ Net Zero Clinical Care Conference 2023 presentation (with SusQI team)

• BMJ Net Zero Clinical Care Conference 2023 – Lynn Riddell from 2022 Northampton competition presented project on reducing low value appointments. Poster presentations from other teams were also shared.

• Sarah Williams and Laura-Marie Baldwin led Gloucester Hospitals FT were nominated for CAHPO (chief allied health profession officer) awards and presented their poster at the ESPEN (European Society for Parenteral and Enteral Nutrition).

• Alex Langstaff and Holly Slyne, two Green Team project leads, are finalists in the Royal College of Nursing Awards 2023, in the Greener Nursing Category. (winners revealed 11th Nov)

• Rachel Mclean - London Sustainability network lunch and learn session on Green teams + SusQI

Growth / Expansion:

•We are excited to host new competitions in 2024, including our very first international competition early in 2024 in collaboration with Alberta Health Services, Canada

Sustainability in Quality Improvement (SusQI)

Small Business Research Institute (SBRI) project funding

For the first 6 months of 2023 our SusQI team received funding and support from the Small Business Research Institute (SBRI) to improve how we market our services and how to increase the patient voice in SusQI. We worked with Glasshouse Health marketing team, and the Health Innovation teams of Oxford and Kent, Surrey and Sussex. This project helped us create a marketing plan and a Public and Patient Involvement and

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Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

Achievements and performance (continued)

Engagement (PPIE) strategy. Our new public representatives recruited through this process, Georgina and Andrea, will be integral to how we implement this strategy. We will be working with Oxfordshire Local Enterprise (OxLEP) and our own communication team to enact our marketing strategy. It was a steep learning curve for the team, and the support from SBRI and our partners was fantastic, and was topped with the SusQI programme being shortlisted as one of five finalists for the 2023 Innovate Award, Net Zero Innovation category. This was in recognition of SusQI's potential to significantly and positively impact the NHS's ambition to reach Net Zero by 2040.

Expanding SusQI Academy and Beacon site programmes

Through 2023 our SusQI Academy and Beacon site programmes, originally funded by Health Education England, The Health Foundation, and King's College London and now self-funding, have seen a growing number and range of member organisations from across the UK, and our first international members in Australia and Canada. Midlands Partnership University NHS Foundation Trust were one of our first healthcare delivery organisations to join the Academy programme and have worked with the SusQI team throughout 2023 to become an established Beacon site. They have now integrated sustainability throughout their QI training programmes and organisational QI approach and have said about the programme.

"We’ve been extremely well supported by the SusQI team at the Centre for Sustainable Healthcare, the approach has been very flexible and how we got there was up to us…having the Academy network to have conversations with other organisations on the same journey proved extremely useful." Helen Payne, Head of Continuous Improvement, MPFT

Annual SusQI Showcase

The fantastic SusQI Showcaseheld in May 2023 showcased great examples of SusQI in practice from a range of our members and partners.

“This was a brilliant event showcasing what is possible using case studies…it's beneficial to everyone working in health, not just NHS teams. Because any new project or initiative simply cannot be incorporated into healthcare systems without the green lens. Thank you for putting this event together!”

SusQI Education

200+ individuals have been trained in 2023 through our Sustainability in Quality Improvement workshops and bespoke courses and sessions including those with the Nuffield Trust, Florence Nightingale Foundation and Royal College of Nurses. The SusQI team had the privilege to be a part of the inaugural Net Zero Clinical Care Conference 2023, hosted by the BMJ and UKHACC, and the Our People Our Planet 2023 event offering the opportunity to engage large and varied audiences in SusQI.

Publication and Materials

In July 2023 two CSH elective volunteers, Jonathan De Oliveira and Will Nash, together with Alice Clack CSH’s 2022/2023 SusQI Education Fellow, and Georgia Galloway, a collaborator with experience in the impact of SusQI teaching published a letter to the editor of Clinical Teacher.

Sustainability in quality improvement: QI fit for the future was in response to a Clinical Teacher article that highlighted a unique method of teaching QI, arguing that all new approaches should help reduce the carbon footprint of the NHS to meet its Net Zero commitments.

In November ahead of COP28 The World Health Organisation’s hosted network Alliance for Transformative Action on Climate and Health (ATACH) launched a new library of case studies. The new library showcases real

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Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

Achievements and performance (continued)

examples of “first wins” achieved by health systems in building climate resilience and/or low carbon sustainability with the aim to support countries in implementing the Operational Framework for Building Climate Resilient and Low Carbon Health Systems. The SusQI team provided a Technical case study for the library, presenting the SusQI framework as a proven approach that combines better quality of care with environmental, social and financial benefits.

Education and Training

In 2023, CSH continued to develop and expand its range of educational initiatives, in support of its strategic objective to provide healthcare staff with the awareness, skills, confidence and motivation to integrate sustainability into clinical culture and healthcare provision.

Highlights include :

“Reminder of key facts; strategies for tackling the problem and getting people around me engaged. Good to have local information.’’ - Carl Edmonds, Deputy Director Programmes

“Helping me consolidate the ideas which have been whizzing around in my head!’’ - Amy Greengrass, Consultant Anaesthetist, Clinical Lead for Sustainability

“Real life examples & the opportunity to reflect and discuss some important questions’’ - Anon.

“The message is clear and concise. I hope we can move forward really positively as an organisation’’ - Dr Emma Radcliffe

“Hayley's presentation was absolutely superb and possibly the best talk through of the co-benefits to health and the system that I've heard (and I've heard a few!)’’ - Dr Emma Radcliffe

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Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

Achievements and performance (continued)

healthcare professionals.

Sustainability analysts

In 2023, CSH’s sustainability analysts provided carbon modelling support for CSH projects. The team supported 15 scholars through the Sustainable Scholars programme, 6 Green Team Competitions, 10 carbon footprinting courses and CSH’s SBRI Phase 1 as well as external consultancy projects.

Highlights include:

Digital transformation : CSH supported two companies in evaluating the environmental impact of using their digital health technologies to streamline care pathways. CSH continued its collaboration with Ufonia, an AI company, to evaluate the potential environmental impact of using automated conversations for pre and post cataract surgery assessment compared to traditional nurse-led and patient-initiated reviews. The pilot phase ended in December, with the final model and report being submitted before the end of 2023. CSH also collaborated with HammondCare to estimate the carbon impact of their HammondCare Virtual Dementia Behaviour Support Clinic (DBSC), a digital App offering carer support for dementia patients experiencing Behaviour and Psychological Symptoms of Dementia (BPSD).

Sustainable Veterinary car : CSH continued to collaborate with the Royal College of Veterinary Surgeons (RCVS) to support veterinary practices in implementing the environmental sustainability module of RCVS’s accreditation scheme which CSH co-developed last year. A webinar on the new environmental sustainability module was developed, including supporting information and content on how practices can achieve the new accreditation standards. CSH also delivered a 3-hour workshop in March for the marketing team at Dechra, a veterinary pharmaceuticals company. The workshop focussed around how Dechra can support veterinary practices to meet their sustainability goals.

Supporting NHS organisations: CSH supported Gloucestershire ICB, Gloucestershire Primary Care (GP) services and Gloucestershire Health and Care NHS Foundation Trust to estimate a baseline carbon footprint to help monitor the impact of carbon reduction initiatives and progress towards net zero.

Carbon footprinting CSH : CSH conducted its first ever internal carbon footprint analysis. As a supplier to the NHS, CSH is committed to reducing its own emissions. Based on our analysis we will develop and publish a carbon reduction plan in line with NHS’s net zero targets and continue to monitor and measure our carbon footprint annually.

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Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

Achievements and performance (continued)

CSH Carbon footprinting course : CSH delivered 10 carbon footprinting workshops and developed a new carbon footprinting course tailored for participants based in the United States. The US course was trialled alongside three of the regular carbon footprinting workshops

“The course has been almost life changing for me. It was the final piece in the jigsaw that allowed me to demonstrate real gains in so many areas. ” - Carbon footprinting course participant 2023

b. Fundraising activities/income generation

CSH has managed to secure new funding and to diversify income streams to take advantage of emerging opportunities which led to an income of £1,584,347 in this financial period.

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 funds 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.

Raising sufficient funds to support all our activities remains a challenge, and at the end of 2023, we were unsuccessful in securing a large-scale fund. Nevertheless, the lessons learned from this experience will benefit us in pursuing future opportunities. The trustees have agreed to continue investing in several staff positions that would have been covered by this funding, in order to retain their specialist expertise while we explore and secure alternative funding sources.

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.

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 December 2023 our monthly operating costs were £105K.

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Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

c. Surplus

This financial period (Nov 2022 – Dec 2023) the charity had an income of £1,584,347 and expenditure of £1,361,215 resulting in an operating surplus for the year amounting to £223,132 which is a combination of restricted funds and unrestricted funds which will help to build our reserves.

The total funds held at the end of the reporting period were £429,423. Of these funds, £374,310 are held for restricted projects and £55,113 held for general purposes.

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 grown 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.

We recognise the need to reduce the team's reliance on restricted funding and increase unrestricted income. To address this, the development team is planning to launch two key initiatives in 2024: a corporate funding programme that will enable companies aligned with our values and mission to support CSH’s work, and a Trust programme designed to establish a membership model for NHS Trusts, who form our primary audience. Alongside these new initiatives, we are also working to grow consultancy income across all of our programmes.

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.

Page 13

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

Structure, governance and management (continued)

c. Organisational structure and decision-making policies

The Trustees meet once every quarter, twice online and twice in person, led 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.

We have conducted a governance review with the Board in 2023 and identified areas which we will work on in 2024.

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.

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 well as growing CSH’s impact in this increasingly prominent field. We start the process of becoming more deliberately international now, where appropriate, to maximise our impact.

For our green space programme, the activities planned for 2024 have continued to focus on larger scale more strategic projects. We will continue to prioritise:

Page 14

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

Plans for future periods (continued)

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.

Our first Chief Operating Officer starts in January 2024 to take on management and HR tasks from the Director/Chief Executive, 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. We will also review the need to bring in more fundraising capacity as we currently only have 0.6 FTE working directly on fundraising.

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:

Page 15

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

Engagement with employees and employment of the disabled (continued)

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.

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 period. 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.

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

Page 16

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

TRUSTEES' REPORT (CONTINUED) FOR THE PERIOD ENDED 31 DECEMBER 2023

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

_________ G Manning (Acting Chair of Trustees) Date: 23-09-24

Page 17

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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 period ended 31 December 2023 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.

Material uncertainty related to going concern

We draw attention to note 2.2 in the financial statements and the financial review section of the Trustee's Report, which indicates that unrestricted funds at the balance sheet date are not sufficient to cover the following month's operating costs. As stated in the financial review section of the Trustee's Report, these events or conditions, indicate that a material uncertainty exists that may cast significant doubt on the charitable company's ability to continue as a going concern. Our opinion is not modified in respect of this matter.

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.

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

Page 18

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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 19

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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 20

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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, Charity Law, Tax and Pensions legislation, employment law, and specific funding agreements.

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.

Page 21

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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 FCCA (Senior statutory auditor)

for and on behalf of Wellers

Statutory Auditors 8 King Edward Street Oxford OX1 4HL

23-09-24 Date:

Page 22

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

STATEMENT OF FINANCIAL ACTIVITIES (INCORPORATING INCOME AND EXPENDITURE ACCOUNT) FOR THE PERIOD ENDED 31 DECEMBER 2023

Note
Income from:
Donations and legacies
4
Charitable activities
5
Total income
Expenditure on:
Charitable activities
6
Total expenditure
Net movement in funds
Reconciliation of funds:
Total funds brought forward
Net movement in funds
Total funds carried forward		 Restricted
funds
2023
£
756,361
-
756,361
369,033
369,033
387,328
(13,018)
387,328
374,310		 Unrestricted
funds
2023
£
158,932
669,054
827,986
992,294
992,294
(164,308)
219,309
(164,308)
55,001		 Total
funds
2023
£
915,293
669,054
1,584,347
1,361,327
1,361,327
223,020
206,291
223,020
429,311		 Total
funds
2022
£
411,513
806,735
1,218,248
1,106,118
1,106,118
112,130
94,161
112,130
206,291

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

The notes on pages 27 to 44 form part of these financial statements.

Page 23

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

BALANCE SHEET AS AT 31 DECEMBER 2023

Note
Fixed assets
Tangible assets
11
Current assets
Debtors
12
Cash at bank and in hand
Creditors: amounts falling due within one
year
13
Net current assets
Total assets less current liabilities
Total net assets
Charity funds
Restricted funds
14
Unrestricted funds
14
Total funds		 78,645
422,428
501,073
(81,368)		 31
December
2023
£
9,606
9,606
419,705
429,311
429,311
374,310
55,001
429,311		 116,519
297,810
414,329
(217,084)		 30
November
2022
£
9,046
9,046
197,245
206,291
206,291
(13,018)
219,309
206,291

Page 24

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

BALANCE SHEET (CONTINUED) AS AT 31 DECEMBER 2023

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: 23-09-24

The notes on pages 27 to 44 form part of these financial statements.

Page 25

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

STATEMENT OF CASH FLOWS FOR THE PERIOD ENDED 31 DECEMBER 2023

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 period
Cash and cash equivalents at the beginning of the period
Cash and cash equivalents at the end of the period
The notes on pages 27 to 44 form part of these financial statements		 2023
£
130,958
(6,340)
(6,340)
-
124,618
297,810
422,428		 2022
£
275,528
(7,498)
(7,498)
-
268,030
29,780
297,810

Page 26

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

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 company's principal 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), 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.

The financial statements are for a period of 13 months, from 1 December 2022 to 31 December 2023. The reason for this extended period is to align the financial year with the calendar year and to align with reporting our impact in a designated year. The comparative amounts presented in the financial statements (and related notes) are therefore not entrirely comparable.

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 17.

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.

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.

Page 27

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

2. Accounting policies (continued)

2.4 Expenditure (continued)

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 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:

2.6 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.

2.7 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.

2.8 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.

Page 28

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

2. Accounting policies (continued)

2.9 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.

2.10 Operating leases

Rentals paid under operating leases are charged to the Statement of financial activities on a straight line basis over the lease term.

2.11 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 period.

2.12 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.

3. Critical accounting estimates and areas of judgment

Estimates and judgments are continually evaluated and are based on historical experience and other factors, including expectations of future events that are believed to be reasonable under the circumstances.

Critical accounting estimates and assumptions:

The company makes estimates and assumptions concerning the future. The resulting accounting estimates and assumptions will, by definition, seldom equal the related actual results. The estimates and assumptions that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year relate to accruals, deferred income, and accrued income.

Critical areas of judgment:

Key judgements that have the most significant effect on the amounts recognised in the financial statements relate to the basis on which support costs including salaries are split across charitable activties.

Page 29

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

4. Income from donations and legacies

Donations
Grants
Total 2023
Donations
Grants
Total 2022		 Restricted
funds
2023
Unrestricted
funds
2023
£
£
-
9,393
756,361
149,539
756,361
158,932
Restricted
funds
2022
Unrestricted
funds
2022
£
£
-
11,244
311,706
88,563
311,706
99,807		 Total
funds
2023
£
9,393
905,900
915,293
Total
funds
2022
£
11,244
400,269
411,513

Page 30

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

5. Income from charitable activities

Income from charitable activities - Clinical
Income from charitable activities - NHS Forest
Total 2023
Income from charitable activities - Clinical
Income from charitable activities - NHS Forest
Total 2022		 Unrestricted
funds
2023
£
519,639
149,415
669,054
Restricted
funds
2022
Unrestricted
funds
2022
£
£
20,000
649,469
-
137,266
20,000
786,735		 Total
funds
2023
£
519,639
149,415
669,054
Total
funds
2022
£
669,469
137,266
806,735

6. Analysis of expenditure on charitable activities

Summary by fund type

Clinical
NHS Forest
Total 2023		 Restricted
funds
2023
Unrestricted
funds
2023
£
£
-
755,197
369,033
237,097
369,033
992,294		 Total
2023
£
755,197
606,130
1,361,327

Page 31

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

6. Analysis of expenditure on charitable activities (continued)

Summary by fund type (continued)

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

Summary by expenditure type

Clinical
NHS Forest
Total 2023
Clinical
NHS Forest
Total 2022		 Staff costs
2023
£
652,583
436,380
1,088,963
Staff costs
2022
£
459,818
347,427
807,245		 Depreciatio
n
2023
Other costs
2023
£
£
3,494
99,120
2,287
167,463
5,781
266,583
Depreciation
2022
Other costs
2022
£
£
2,058
146,207
1,058
149,550
3,116
295,757		 Total
2023
£
755,197
606,130
1,361,327
Total
2022
£
608,082
498,037
1,106,118

Page 32

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

7. Analysis of expenditure by activities

Clinical
NHS Forest
Total 2023
Clinical
NHS Forest
Total 2022		 Activities
undertaken
directly
2023
£
706,601
540,589
1,247,190
Activities
undertaken
directly
2022
£
554,950
430,432
985,382		 Support
costs
2023
£
48,596
65,541
114,137
Support
costs
2022
£
53,131
67,606
120,737		 Total
funds
2023
£
755,197
606,130
1,361,327
Total
funds
2022
£
608,081
498,038
1,106,118

Page 33

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

7. Analysis of expenditure by activities (continued)

Analysis of direct costs

Staff costs
Depreciation
Project costs
Project publications, leaflets and maps
Professional and consultancy
Website and computer costs
Travel and subsistence
Printing, postage and stationery
Miscellaneous
Bank charges
Conference costs
Sub-contractors costs
Total 2023
Staff costs
Project costs
Miscellaneous
Conference costs
Total 2022		 Clinical
2023
£
652,583
-
28,083
43
15,400
-
-
40
1,383
-
7,219
1,850
706,601
Clinical
2022
£
459,819
91,696
870
2,566
554,951		 NHS Forest
2023
£
436,380
226
94,778
44
-
3,313
857
32
1,295
47
2,450
1,167
540,589
NHS Forest
2022
£
347,426
82,135
870
-
430,431		 Total
funds
2023
£
1,088,963
226
122,861
87
15,400
3,313
857
72
2,678
47
9,669
3,017
1,247,190
Total
funds
2022
£
807,245
173,831
1,740
2,566
985,382

Page 34

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

7. Analysis of expenditure by activities (continued)

Analysis of support costs

Depreciation
Website and network costs
Travel and subsistence
Printing, postage and stationery
Office expenses
Telephone
Miscellaneous
Bank charges
Insurance
Payments to charitable parties
Training
Governance costs
Total 2023		 Clinical
2023
£
3,494
8,221
10,099
485
-
221
2,057
464
732
1,486
6,050
15,287
48,596		 NHS Forest
2023
£
2,061
32,831
8,130
588
1,222
213
3,791
306
733
175
203
15,288
65,541		 Total
funds
2023
£
5,555
41,052
18,229
1,073
1,222
434
5,848
770
1,465
1,661
6,253
30,575
114,137

Page 35

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

7. Analysis of expenditure by activities (continued)

Analysis of support costs (continued)

Clinical
2022
£
Depreciation
2,058
Professional and consultancy
20
Website and network costs
25,080
Travel and subsistence
2,806
Printing, postage and stationery
17
Office expenses
-
Entertainment
1,211
Telephone
381
Miscellaneous
1,535
Repairs and maintenance
346
Bank charges
533
Rent
7,635
Insurance
1,274
Payments to charitable parties
1,418
Training
2,796
Governance costs
6,021
Total 2022
53,131
8.
Auditors' remuneration
Fees payable to the company's auditor for the audit of the company's
annual accounts
Fees payable to the company's auditor in respect of:
All non-audit services not included above		 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
2023
£
7,000
23,575		 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
2022
£
5,300
8,156

Page 36

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

9. Staff costs

Wages and salaries
Social security costs
Contribution to defined contribution pension schemes		 2023
£
956,972
81,790
50,201
1,088,963		 2022
£
702,959
67,582
36,703
807,244

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

Trustee
Administration		 2023
No.
1
28
29		 2022
No.
1
25
26

No employee received remuneration amounting to more than £60,000 in either year.

The total remuneration and benefits received by the key management personel was £117,325 (2022 - £94,568).

10. Trustees' remuneration and expenses

During the period, 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:

2023 2022
£ £
Remuneration and pension
Rachel Stancliffe contributions 62,661 52,245
During the period ended 31 December 2023, expenses were reimbursed or paid directly to 1 Trustee
_(2022 - to 1 Trustee)_broken down as follows:
2023 2022
£ £
Travel, subsistence and meeting costs 533 2,423

Page 37

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

11.
Tangible fixed assets
Cost or valuation
At 1 December 2022
Additions
At 31 December 2023
Depreciation
At 1 December 2022
Charge for the period
At 31 December 2023
Net book value
At 31 December 2023
At 30 November 2022		 Office
equipment
£
15,330
6,340
21,670
6,284
5,780
12,064
9,606
9,046

Page 38

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

(A company limited by guarantee)

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

12. Debtors

Due within one year
Trade debtors
Other debtors
Prepayments and accrued income		 31
December
2023
£
36,779
38,280
3,586
78,645		 30
November
2022
£
115,632
-
887
116,519

13. 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 2022
Resources deferred during the period
Amounts released from previous periods		 31
December
2023
£
1,051
33,303
9,463
37,551
81,368
31
December
2023
£
153,615
60,881
(190,925)
23,571		 30
November
2022
£
14,633
42,647
889
158,915
217,084
30
November
2022
£
68,536
234,232
(149,153)
153,615

Income is deferred as money was received in advance for projects delivered over a timeframe which partly related to the following accounting period.

Page 39

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

14. Statement of funds

Statement of funds - current period

Balance at 1
December
2022
£
Unrestricted funds
General Funds
219,309
Restricted funds
SBRI
(8,861)
Woodland Creation
-
Tree Call To Action
(4,157)
(13,018)
Total of funds
206,291		 Income
£
Expenditure
£
827,986
(992,294)
92,984
(84,123)
471,700
(95,297)
191,677
(189,613)
756,361
(369,033)
1,584,347
(1,361,327)		 Balance at
31
December
2023
£
55,001
-
376,403
(2,093)
374,310
429,311

The SBRI restricted fund relates to funding from SBRI for the SusQI commercialisation project: Net Zero Is In Your Hands to cover the costs for staff and systems development of the project.

The Woodland Creation restricted fund relates to funding from Department for Environment Food & Rural Affairs (DEFRA) to plant 150,000 trees on the NHS Estate. The activities funded by this grant include costs for staff to deliver the project, along with the costs of planting and protecting the new trees across the NHS Estate.

The Tree Call To Action restricted fund relates to funding from National Heritage Memorial Fund (NHMF) on behalf of DEFRA. The funding is to be spent on activities including; further tree planting on NHS sites, training in tree planting for NHS staff and volunteers, placements for medical healthcare students to support the project, hosting of the NHS Forest Conferences in 2022-2024, establishing the NHS Forest Advisory Group, and associated staff roles to enable delivery of the projects activities.

Page 40

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

14. Statement of funds (continued)

Statement of funds - prior period

Unrestricted funds
General Funds
Restricted funds
HF South Warwickshire
SBRI
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)		 Balance at
30
November
2022
£
219,309
-
(8,861)
(4,157)
-
(13,018)
206,291

Page 41

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

15. Summary of funds

Summary of funds - current period

Balance at 1
December
2022
£
General funds
219,309
Restricted funds
(13,018)
206,291
Summary of funds - prior period
Balance at
1 December
2021
£
General funds
84,924
Restricted funds
9,237
94,161		 Income
£
Expenditure
£
827,986
(992,294)
756,361
(369,033)
1,584,347
(1,361,327)
Income
£
Expenditure
£
886,542
(752,157)
331,706
(353,961)
1,218,248
(1,106,118)		 Balance at
31
December
2023
£
55,001
374,310
429,311
Balance at
30
November
2022
£
219,309
(13,018)
206,291

16. Analysis of net assets between funds Analysis of net assets between funds - current period

Tangible fixed assets
Current assets
Creditors due within one year
Total		 Restricted
funds
31
December
2023
Unrestricted
funds
31
December
2023
£
£
-
9,606
374,310
126,763
-
(81,368)
374,310
55,001		 Total
funds
31
December
2023
£
9,606
501,073
(81,368)
429,311

Page 42

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

16. Analysis of net assets between funds (continued)

Analysis of net assets between funds - prior period

Tangible fixed assets
Current assets
Creditors due within one year
Total		 Restricted
funds
30
November
2022
£
-
-
(13,018)
(13,018)		 Unrestricted
funds
30
November
2022
£
9,046
414,329
(204,066)
219,309		 Total
funds
30
November
2022
£
9,046
414,329
(217,084)
206,291

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

18.

Net income for the period (as per Statement of Financial Activities)
Adjustments for:
Depreciation charges
Decrease in debtors
Increase/(decrease) in creditors
Net cash provided by operating activities
Analysis of cash and cash equivalents
Cash in hand
Total cash and cash equivalents		 31
December
2023
£
223,020
5,780
37,874
(135,716)
130,958
31
December
2023
£
422,428
422,428		 30
November
2022
£
112,130
3,116
62,917
97,365
275,528
30
November
2022
£
297,810
297,810

Page 43

Docusign Envelope ID: 455BB2BF-C440-4306-990E-FF067A336AF1

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 31 DECEMBER 2023

19. Analysis of changes in net debt

Cash at bank and in hand At 1
December
2022
£
297,810
297,810		 Cash flows
£
124,618
124,618		 At 31
December
2023
£
422,428
422,428

20. 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 £50,200 (2022 - £36,703).

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.

22. Related party transactions

During the year, payments were made to JRG Coaching Limited, a company connected to trustee Jessie Rhys-Griffith, amounting to £12,786 in respect of consultancy services (2022 - nil).

Page 44