2024-12-31-accounts

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

Registered number: 07450026 Charity number: 1143189

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

(A company limited by guarantee)

TRUSTEES' REPORT AND FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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 - 19
Independent auditors' report on the financial statements	20 - 23
Statement of financial activities	24
Balance sheet	25 - 26
Statement of cash flows	27
Notes to the financial statements	28 - 49

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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 31 DECEMBER 2024

Trustees	Gill Manning, Chair
	Rachel Stancliffe (resigned 10 December 2024)
	Michael Smeeth (resigned 10 December 2024)
	Jessica Rhys-Griffith (resigned 10 September 2024)
	Duncan Mackay
	Clare Scully (appointed 13 September 2024)
	Joanna Romanowicz (appointed 13 September 2024)
	Dr Mike Tomson
	Hazel Walsh, Secretary (appointed 17 December 2024)
	Iris Blom (appointed 13 September 2024)
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 (resigned 1 March 2024) Helen Sullivan (appointed 1 March 2024, resigned 17 December 2024) Hazel Walsh (appointed 17 December 2024) Chief executive officer R Stancliffe Independent auditors Wellers Statutory Auditors 8 King Edward Street Oxford OX1 4HL Website https://sustainablehealthcare.org.uk

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

The Trustees present their annual report together with the audited financial statements of the company for the year 1 January 2024 to 31 December 2024. 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: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

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 for communities in healthcare to share ideas and questions about sustainability.

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 health staff, patients and visitors with sustainability. 11. Working with NHS and other healthcare organisations to make the links between health and the environment through the NHS Forest and other green space projects.

11. Improving access to green space associated with healthcare, with the aim of improving health.

d. Volunteers

CSH continues to benefit from volunteers who have worked on central projects and tasks. During 2024 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 at least one month. We had 37 volunteers and students on elective placements contributing a total of 2.45 FTE to our staff team across the year. In addition, 120 Liverpool green space volunteers contributed 818 hours and 99 hours of work experience were provided to five neurodiverse young adults through Project SEARCH.

In July, we launched our NHS Forest Volunteer Matching Service to support healthcare sites find and connect volunteers to help develop their green space projects. Volunteers can sign up for notifications and then contact sites directly to make arrangements.

Achievements and performance

a. Review of activities

CSH has had an extremely busy year in 2024 with both ongoing and new projects.

• 51 presentations at external events and conferences

• 27,261 trees planted at 113 NHS sites, more than ever before in one year

• 32 news stories and blogs published and 14 peer-reviewed articles

• The Networks Platform has grown by 25%, with now over 7922 members worldwide in 36 networks

• 306,000 website sessions; 371,000 twitter impressions &13,000 followers; 5,564 followers on LinkedIn • 37 individuals (including 13 medical students) contributed 4,780 hours, equivalent to 2.45 full time staff.

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 2024, bringing the total to 14, and 866 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.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

Achievements and performance (continued)

CSH continued expanding its Clinical Transformation work with major international collaborations and impactful UK-based projects. The Green Team Competitions were delivered across multiple NHS trusts and internationally, including the first competition in Alberta, Canada. Notable outcomes included £365,991 and 108,212 kgCO2e saved at Hampshire Hospitals NHS Trust, and $221,627 CAD (~£124,639) and 30,981 kgCO2e saved at South Health Campus in Canada.

The 4-year EU Horizon-funded KitNewCare project started, focusing on sustainable kidney care across four pilot sites in different countries. It selected 28 sustainable optimisations (13 to be implemented in 2025), trained 141 staff, and launched an 8-hour online course in five languages. The Medicines Waste in Care Homes project received £40,000 in funding and established four hubs to assess medicine pathways.

Through the SusQI programme, CSH trained 193 healthcare professionals and supported NHS England with a project surveying over 300 nurses and midwives. This work informed strategies to enhance education and sustainability practices. Contributions were also made to healthcare sustainability tools, such as the Green Impact Tool and the e-LfH modules.

The NHS Forest team planted 27,261 trees at 113 NHS sites in 2024, more than ever in a year before – thanks to a project funded by Defra and the Forestry Commission. Alongside this, funding from the Trees Call to Action Fund continued to allow the team to develop the NHS Forest resources and training offers for healthcare staff, alongside GIS mapping work.

In October 2024 we held our first ever hybrid NHS Forest Conference, with the theme of trees and woodlands as a healthcare asset, attracting 690 online attendees and 66 delegates in person, including healthcare staff, outdoor space charities, researchers and artists.

Staffing changes

In 2024, CSH continued growth with some staff turnover, and now has 32 staff. In the Green Space Programme Sarah Jordan, Programme Director, went on maternity leave and Liz Rees was hired to cover for her for the year. In the Clinical Programme Syed Hussain, Rachael Ward and Ben Whittaker left due to lack of funding for their roles and Siobhan Parslow-Williams left for another job. We were lucky to recruit 3 excellent people into the Kit New Care European project: Harriet Atwell, Aycan Yasar and Lucy Brown; and a nephrologist from Spain, Marta Arias joined us on secondment for one year. For the core team, Helen Sullivan, our first COO, left in December and we have appointed Hazel Walsh internally to take on this role.

Green Space Programme in 2023/24

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 this year focused on integrating trees and woodlands into the NHS, demonstrating how they are a critical and under-utilised healthcare asset that should not be taken for granted. Throughout 2024, 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

Sarah Jordan, our Green Space for Health Director, went on maternity leave in May and we were very pleased to appoint Liz Rees to cover her work until 2025. We were unable to secure ongoing funding for Billy Styles, our nature recovery ranger at Mount Vernon, but continued to fund Nick White at Liverpool. We have put in an

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

Achievements and performance (continued)

application to the Community Lottery Fund for a large project to extend the number of sites that have a ranger. This would start in 2025.

Improving biodiversity on the NHS estate

This year we have continued to take a more strategic approach to tree planting, conducting mapping exercises with the support of a volunteer highly skilled in ArcGIS across three ICS regions – Dorset, Cheshire and Merseyside and Greater Manchester – to identify opportunities to connect trees and woodlands across the NHS estate. We also provided ecological advice to a further 9 NHS sites in addition to the 6 who received this in 2023, supporting them to plan how to make best use of their land for biodiversity.

During the 2023/24 planting season we planted 27,261 trees at 113 NHS sites, including hedgerows and woodlands. We have now planted over 133,000 trees across 400+ NHS sites since the NHS Forest came to life in 2009. We are grateful for the support of our corporate and individual donors, the Trees Call to Action Fund and Nature for Climate fund for enabling this work to take place at such scale this season.

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 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.

We are pleased to share news of an exciting new partnership with the Forestry Commission (FC), through which we have been successful in securing funding from Sport England to develop two new Green Health Routes on FC sites in the North-East of England. Recruitment for the new Green Health Routes Project Lead role took place in 2024, with the successful candidate due to join the team in early 2025.

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 enables decision makers, including those at healthcare sites, to prioritise tree planting efforts where they are needed most. In 2024 we have continued to promote the Tree Equity Score to help tackle health inequalities and encourage NHS staff to utilise this as an invaluable tool in arguing the case for tree planting on sites and in areas that are currently lacking and most in need of trees.

NHS Forest Conference

In October 2024, we held our annual NHS Forest conference, this year with a focus on trees and woodlands as a healthcare asset. It was our first ever hybrid conference taking place online and in-person at Glenfield Hospital in Leicester, chaired by Professor Baroness Kathy Willis.

The conference attracted 66 in-person sign-ups and a record 690 online sign-ups, and recordings of the speakers are available on our website. In-person attendees were offered the opportunity to take a lunchtime tour of Glenfield’s walled Victorian ‘Secret Garden’, while online attendees were able to take part in a speed networking session. The conference announced our NHS Forest Awards Winners for 2024, for healthcare sites going above and beyond in promoting biodiversity and connecting people with nature.

“I attended the brilliant NHS Forest conference today and I can almost taste the opportunities for

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

Achievements and performance (continued)

changing the landscape of health and healthcare in the UK if only we all worked together to embed nature and movement in everything we do.”

– NHS Forest Conference Participant , 2024

“ Thanks for a hugely inspiring and informative event – and thanks particularly to the online attendees for a lively and engaging chat forum too. Great to make new connections and I look forward to more in the future.”

• NHS Forest Conference Participant , 2024

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 Dr Mark Hayden, Consultant in Cardiac Intensive Care at Great Ormond St Hospital.

Supporting Volunteering

This year we have engaged and supported 10 volunteers in the central Green Space team, contributing 228 hours in total. They have added value to the team by contributing their expertise and insights, enhancing our capacity to deliver our current projects as well as developing future opportunities. Their support has covered a variety of areas including:

• Assisting with our mapping work to identify habitat creation opportunities across three ICS regions.

• Developing our nature-based interventions training offer for healthcare professionals.

• Supporting a variety of administrative tasks and developing new comms and marketing content.

• Supporting our horizon scanning work to develop a legacy project for 2025.

• Reviewing NHS Trust Green Plans for biodiversity commitments and targets.

In addition, 120 Liverpool volunteers contributed 818 hours; and 99 hours of work experience were provided to five neurodiverse young adults through Project SEARCH.

New – Volunteer Matching Service for NHS sites

In July, we launched our NHS Forest Volunteer Matching Service to support healthcare sites find and connect volunteers to help develop their green space projects. Volunteers can sign up for notifications and then contact sites directly to make arrangements.

Focus on: Project Search, Liverpool University Hospitals NHS Foundation Trust

Liverpool nature recovery ranger, Nicholas White has worked closely with Greenbank and Liverpool colleges and HFT employability coaches who deliver supported internships at Liverpool University Hospitals NHS Foundation Trust for young people with learning disabilities, neurodiversity, and other complex needs through DFN Project Search.

In 2024, Nicholas received the outstanding mentorship award for his dedicated work with one of our interns SA who has autism and a keen interest in gardening. Initially, finding the right mentor for SA was challenging, as he required a mentor who could understand his specific needs, such as adhering to a precise schedule and having clear plans in advance.

SA made remarkable progress, not only did he graduate successfully, but he also received the award for the most progressed intern. SA developed numerous employability skills and is on the brink of securing employment. Nick's support did not end with the placement; he continues to engage SA in volunteering activities, further nurturing his development. His efforts have not only benefited SA but have also enriched the entire DFN Project SEARCH community.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

Achievements and performance (continued)

“Mentors like Nick are crucial to the success of our programme and to creating an inclusive world where everyone can thrive.” - Bhumika Plan, Employability Coach, HFT, DFN Project Search.

For our 2024 Tree Week campaign, we ran a week full of webinars, events and blogs. We also worked with our long-term supporters RSK to produce an in-depth document in which their landscape architects took time to dispel the myths which often arise around tree planting on the NHS Estate. In Liverpool our Nature Recovery Ranger led a series of tree planting sessions which involved hospital staff and members of the wider community.

We ran our fully booked Green Space for Health training again in February and again in November 2024 after updating the course to include more information about trees and woodlands. 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.

We are very grateful to all our funders. Several sponsors, including RSK, have made contributions to the NHS Forest, including financial tree sponsorship and pro bono support. DSM have funded our Liverpool Nature Recovery Ranger post in 2024.

Looking forward

We are anticipating planting a further 21,000 trees in the 2024/25 planting season, largely funded by the DEFRA Nature for Climate fund delivered through the Forestry Commission. We will also be offering 2,000 fully funded orchard fruit trees for the first time; we are excited to use orchards on healthcare sites as a starting point to talk about food security. Thanks to funding from the Trees Call to Action Fund we are also providing sites receiving these fruit trees with training from The Orchard Project in orchard design and maintenance. Both of these funding pots are running until March 2025.

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 started to design and develop this offer during 2024, ready to start building income by 2025.

Clinical Programme: Highlights in 2024

The Clinical Transformation team has continued its work to equip people with the knowledge and tools needed to drive sustainable healthcare transformation. Our Green Team Competitions and SusQI Academy have supported organisations in engaging clinical staff and embedding sustainability within their Quality Improvement approach. Meanwhile, new projects in maternity care, nursing homes, and living kidney donation have demonstrated how pathway analysis can be effectively combined with clinical engagement.

2024 was a significant year for international expansion. We navigated time zones to run our first international Green Team Competition in Alberta, Canada, while in Europe, we launched the four-year, EU-funded KitNewCare project on sustainable kidney care.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

Achievements and performance (continued)

Sustainable Specialties

The KitNewCare (KNC) project, co-funded by Horizon Europe’s health programme and UKRI, seeks to develop a model for sustainable healthcare, with kidney care as its focus. It addresses the triple challenge of improving knowledge among healthcare professionals and organisations, increasing the availability of sustainable solutions, and advancing their implementation and spread. As part of our new Sustainable Specialties strategy, KitNewCare will generate a tested model for specialty transformation.

"The KitNewCare project is a pivotal step towards aligning kidney care with the UN Sustainable Development Goals and the EU Green Deal. Our vision is to revolutionise healthcare by introducing sustainable technologies that minimise environmental impact while maintaining excellent patient care. With the expertise of our European partners, KitNewCare will serve as a beacon for a more sustainable healthcare future." - Brett Duane, Principal Investigator, Trinity College Dublin

The project will conduct an EU-wide mapping of the sustainability landscape in kidney care and carry out a four impact factor Life Cycle Assessment (LCA), assessing health outcomes, environmental and social impacts, and costs across four kidney care pathways: peritoneal dialysis, haemodialysis, transplant, and conservative therapy. This will take place at the project’s four pilot sites in Modena, Madrid, Warsaw, and Utrecht. The insights will inform the development of sustainable workflow and organisational optimisations, as well as the refinement and piloting of technological innovations at these sites.

Based on the outcomes, best practice guidelines and recommendations, along with an actionable dashboard, will be developed. The project’s insights, solutions, tools, and policy recommendations will inform decision makers and healthcare providers not just in relation to kidney care, but also across other clinical specialties. It will contribute to achieving the goals of the European Green Deal.

CSH leads KitNewCare’s work packages focusing on the development and implementation of optimisations (Work Package 3), the development of the benchmarking dashboard and best practice guidelines (Work Package 5), and education (Work Package 6).

• Launch event, March 2024: The project was officially launched during a two-day event in March 2024 in Malmö. The face-to-face event created a strong foundation for collaboration between the consortium partners.

• Work Package 3 developed a prioritisation matrix, serving as a robust database of both actual and proposed sustainable optimisations, with a focus on feasibility and impact. The team worked intensively with the clinical teams at the four pilot sites to select fitting optimisations for testing within the project. A total of 28 optimisations have been chosen, with the first 13 scheduled for implementation in 2025.

• Work Package 5 held its first workshop with the clinical sites to explore and agree on the four impact indicators and metrics that will be measured and monitored by the benchmarking tool.

• Work Package 6 successfully trained 141 staff members in sustainable healthcare and sustainable kidney care during site visits and online sessions. Additionally, an eight-hour sustainable kidney care online course was developed, available in five languages.

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.

In 2024, CSH collaborated with multiple organisations to deliver Green Team Competitions, including our first

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

(A company limited by guarantee)

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

Achievements and performance (continued)

Integrated Care System (ICS)-wide competition and our first international competition. These initiatives have empowered healthcare teams to embed sustainable practices into their work, driving meaningful change across a wide range of settings.

• Royal United Hospitals Bath NHS Foundation Trust

• Hampshire Hospitals NHS Foundation Trust

• Northampton General Hospital NHS Trust

• Coventry and Warwickshire ICS – A partnership involving: Coventry and Warwickshire Partnership NHS Trust, George Eliot Hospital NHS Trust, South Warwickshire NHS Foundation Trust and University Hospitals Coventry and Warwickshire NHS Trust

• South Health Campus, Alberta Health Services, Calgary, Canada

Competition submissions, Recognitions, Awards and Publications

Several Green Team competitions received national recognition:

• The Pharmacy Team from Hampshire’s 2023 Competition was featured in the Pharmaceutical Journal for their innovative medicine reuse scheme.

• Two Green Teams were nominated for the 2024 HSJ Towards Net Zero Award: Catering at Hampshire and Hand Therapy from Northampton, which was highly commended.

• North-East London was also nominated for its sustainability work, which included a Green Team Competition, participation in CSH courses and the SusQI Academy.

• The Northampton Hand Therapy team was awarded the abstract prize at the 2024 SHARE Conference.

In addition to these competitions, we partnered with the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) to deliver the first-ever National Green Maternity Challenge. This initiative, initially funded by SBRI, received an overwhelming number of applications, prompting RCOG to provide additional funding, expanding the programme to support nine project teams dedicated to creating more sustainable and equitable maternity care.

Events, Conferences, and Talks

We were privileged to contribute to several key talks, workshops, and webinars, engaging diverse audiences across different healthcare disciplines. Highlights included:

• Queen’s Nursing Institute Sustainable Healthcare Series, with 50–80 attendees per session

• Joint BASHH & FSRH Virtual Webinar, engaging 300 attendees

• Warwick Medical Students for a training session

• QNI Innovation face-to-face workshop for 25 Innovation Nurses working on funded Quality Improvement projects

• KCL IPE Workshop

• BASL Webinar

Our presence at conferences and forums further embedded sustainability into healthcare education and practice, with contributions to:

• AMEE

• 2024 SHARE Conference, where Green Teams made up one-third of total presenters and Rachel McLean, our SusQI Programme Lead for Competitions and Specialties, presented the Green Team Evaluation.

• The Northampton Hand Therapy Team, Hampshire Theatres Team, and North-East London Limb Reconstruction Team showcased their sustainability projects during Greener AHP Week, alongside a SusQI presentation by Rachel McLean.

• IHI/BMJ International Forum on Quality & Safety in Healthcare, with three Green Team Competition submissions

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

Achievements and performance (continued)

Sustainability in Quality Improvement (SusQI)

In 2024, the SusQI programme has continued to deliver on our strategic aim of integrating environmental and social sustainability into Quality Improvement education, training, and practice across all health professions. This has been achieved through our core services—including the Green Teams Competition, SusQI Academy, Beacon Site programmes, and education courses—as well as through consultancy work.

Expanding SusQI Academy and Beacon site programmes

Throughout 2024, we have continued to collaborate with a diverse range of member organisations from across the UK and internationally, supporting them in embedding sustainability principles into their education, Quality Improvement (QI) programmes, and practice.

In partnership with CSH, three healthcare delivery organisations hosted a well-attended online Q visit, providing valuable insights and practical approaches to sustainable healthcare. Member organisations shared their experiences, while attendee feedback highlighted the impact and relevance of the session in driving forward sustainability efforts within healthcare settings.

The Nursing and Midwifery Insights Survey

In 2024, members of the SusQI team successfully led a bid and secured a tendered project for NHS England, focusing on quality improvement by exploring the insights and behaviours of nurses and midwives.

The project involved surveying over 300 individuals and conducting in-depth interviews with a selection of nurses and midwives across various healthcare settings and specialties. The findings have contributed to wider discussions within NHS England and are now driving initiatives to upskill and educate nurses and midwives on a larger scale.

Annual SusQI Showcase

In June 2024, we held our annual SusQI Showcase, our biggest event yet in terms of both attendance and impact. The event highlighted outstanding examples of SusQI in practice, featuring contributions from a diverse range of members and partners. This year, there was a particular emphasis on Patient and Public Involvement and Engagement (PPIE) inclusion, ensuring that sustainability efforts are shaped by those they most impact.

“The session was inspiring from start to finish and showed how small interventions can make an impact on patient care, work volume, carbon footprint and financial savings. All members of the healthcare team can question a process and make impactful changes.”

Consultancy work

The SusQI team, in collaboration with supervised CSH volunteers, worked alongside ISQua and the Geneva Sustainability Centre to design and develop content for a new Sustainability in Healthcare Fellowship programme. The six-module programme was successfully completed at the end of 2024 and is now live.

SusQI Education

In 2024, we continued to expand the reach of our Sustainability in Quality Improvement (SusQI) training, equipping over 193 healthcare professionals through workshops, bespoke courses, and tailored sessions.

Our training was delivered in collaboration with organisations such as the Nuffield Trust, Florence Nightingale Foundation, and Royal College of Nurses, as well as through a variety of high-impact events.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

Achievements and performance (continued)

Tools and materials

• Beyond training, our team played a role in shaping sustainable healthcare tools and frameworks, contributing to: • The Green Impact Tool review

• The development of e-Learning for Healthcare (eLFH) modules in Endoscopy and Operating Theatres

• The SQUIRE Environmental Sustainability extension

• The creation of an ISQUA Fellowship online module

Networks

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

The CSH Networks Platform grew by 25% in 2024 to 7,922 members globally, with 1,221 resources and ~30,000 library views. The platform supports 36 specialty networks, enabling collaboration among healthcare professionals, patients, educators, and researchers.

Events included Greener AHP Week (31 events) and a high-engagement session on disposable instruments (174 participants). A new Greener Palliative Care Award launched with 10 pilot organisations. The Kidney SusNet is set for expansion in 2025 under the KitNewCare project.

“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 sources of core funding.

Education and Training

This year, we launched a new platform for our online learning modules, bringing a range of benefits to both user experience and learning outcomes, including:

• A clearer and more intuitive booking process.

• Instant access to learning materials at the time of booking.

• A personalised homepage displaying all booked courses.

• Courses structured into bite-sized modules to support self-directed learning.

• Progress tracking, enabling users to easily resume where they left off.

• Knowledge-check quizzes at the end of each module to reinforce learning.

• Separate completion certificates for both the online modules and the workshop.

The new platform also offers significant ‘back-end’ improvements, such as streamlined content review and updates, as well as enhanced data analysis. These enhancements will lead to greater accuracy and higher quality in our online learning materials.

Highlights include:

Short Courses. CSH Short Courses provide a valuable introduction to the principles of sustainable healthcare and the opportunity for all participants to develop and implement a project to reduce the carbon footprint in their

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

Achievements and performance (continued)

own area of work. A total of 866 healthcare professionals completed CSH Short Courses in 2024, and many return for ongoing mentoring and guidance for their local projects in our Sustainable Healthcare Cafés. Feedback has been overwhelmingly positive with over 96% saying they would recommend Foundation courses to colleagues.

Net Zero Leadership training. Launched in 2022 as ‘board level training’, our Net Zero Leadership training programme continued to expand in 2024 with 15 bespoke programmes delivered to leadership groups, including ICBs and Trust boards, across England and Wales. These courses provide an invaluable opportunity for healthcare leaders to review and develop their sustainability and green plans in a way which ensures organisational buyin, culture change and systemwide impact. Participants receive ongoing support from CSH to deliver outcomes which balance clinical quality, financial efficiency, and environmental and social benefits.

“The workshop, facilitators were absolutely fantastic start to finish!” Workshop Attendee, 2024

“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

National e-learning modules . CSH provides free introductory e-learning modules to UK residents via Health Education England’s eLearning for Health (eLfH) platform. In 2024, we launched a fourth module on Greenspace and Health. These modules are certified by eLfH and provide a useful entry point to understanding the principles of sustainable healthcare and the opportunities for positive change available to

Consultation and Collaboration. Due to the quality and growing reach of our educational programme, the CSH Education team is increasingly invited to advise, participate and collaborate on projects to support sustainable healthcare. In 2024, we worked intensively with the Centre for Healthcare Innovation in Singapore to train them to deliver our courses.

The education team engaged in a range of activities in collaboration with key partners, expanding the reach and impact of sustainable healthcare education:

• Webinars for Healthcare Schools – Delivered a two-part webinar series, Principles of Sustainable Healthcare and Greening the Curriculum, along with supporting resources, to students and staff in medicine, dentistry, pharmacy, nursing, and allied health professions at Trinity College Dublin. These are available to view here.

• Project Partnership – Currently partnering on the HRB Climate Change and Sustainability Education for Healthcare Professionals project, hosted by University College Cork, to support climate-resilient and sustainable healthcare systems. Learn more.

• Pharmacy Education Publication – Published an educational article, Principles of Sustainable Healthcare in Pharmacy Practice, in the Pharmaceutical Journal. Read it here.

• Sustainable Pharmacy Practice Presentations – Delivered presentations on sustainable pharmacy practice to key audiences, including: NHSE Pharmacy Team (North East and Yorkshire) in December, Cardiff Chief Pharmacists Conference in May, and Clinical Pharmacy Congress North in November

• Specialist Webinars – Delivered a webinar series for the British Society of Gastroenterology.

• Global Workforce Guidance – Developed a comprehensive sustainable healthcare guidance document, including a supporting PowerPoint and questionnaire, for the global workforce of the Aga Khan Foundation.

• Keynote Presentation – Delivered a keynote address at the Westminster Policy Forum, titled Next Steps for Net Zero and Sustainability in the NHS.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

Achievements and performance (continued)

Practical training in sustainable healthcare . The CSH Education programme is supported by a number of committed volunteers. Some have volunteered alongside a regular job, others intensively during the university holiday months, and some in their retirement. In 2024, 37 individuals volunteered 4,721 hours of work to CSH, equivalent to 2.5 fulltime employees.

Sustainability analysts

In 2024, CSH's sustainability analysts supported both CSH-led and external consultancy projects. Within the organisation, the team contributed to six Green Team Competitions, including the Maternity Specialty Challenge, and delivered ten Carbon Footprinting for Healthcare workshops.

Additionally, the team conducted carbon footprint analyses for key CSH-led initiatives, including the SBRI Maternity Project, the Nursing Insights Project, and Phase 1 of the Living Kidney Donor Project.

Highlights include:

Carbon footprint analysis support of three SBRI projects:

1. Intensive Care Sustainability Recipe Book – Led the environmental impact analysis and carbon footprinting of various ICU procedures to support the creation of the Intensive Care Sustainability Recipe Book. This project is a collaborative effort with the Faculty of Intensive Care Medicine, University of Brighton, Intensive Care Society, and the UK Critical Care Nursing Alliance.

2. Rewire Rehab Evaluation – Assessed the environmental and cost impact of Rewire Rehab, a community stroke rehabilitation app designed to deliver personalised neurorehabilitation and maximise stroke recovery.

3. Maternity Care Pathways – Conducted carbon footprint analyses for seven selected maternity care pathways. This work forms part of a broader project aimed at developing low-carbon, equitable maternity care, led by CSH in collaboration with the Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives (RCM), and the Sustainable Healthcare Coalition (SHC).

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 Hammond Care to estimate the carbon impact of their Hammond Care Virtual Dementia Behaviour Support Clinic (DBSC), a digital App offering carer support for dementia patients experiencing Behaviour and Psychological Symptoms of Dementia (BPSD).

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: As a supplier to the NHS, CSH is committed to reducing its own emissions. Based on our internal analysis we have developed and published a carbon reduction plan in line with NHS’s net zero targets and continue to monitor and measure our carbon footprint annually.

CSH Carbon footprinting course: CSH delivered 10 carbon footprinting workshops including a new carbon footprinting course tailored for participants based in the United States.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

Achievements and performance (continued)

“ 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

In 2024, CSH secured £1.28 million in income: 49% from grants, 50% from services, and 1% from donations and sponsorships. Expenditure was split 75% on programmes/projects and 25% on core operations. Focus was placed on building unrestricted reserves and improving financial resilience.

Our resources are dedicated to maximising impact and driving sustainable change in healthcare. Over 75% of our expenditure supports staff directly delivering education, training, mentoring, and consultancy services. This reflects our commitment to catalysing transformation by partnering with influential organisations and empowering individual ‘green champions’ to create change within their workplaces.

The 3 main sources of grant income for this period were: The Green Recovery Challenge Fund, Trees Call to Action Fund and the EU Horizon/UKRI. Additional funding was secured from Natural England, The Health Foundation and Greener NHS amongst others.

Sponsorship has been provided by various supportive companies including RSK and Microtech.

Service income has been made up of selling our training courses and SusQI services plus consultancy.

Raising sufficient funds to support all our activities remains a challenge, but we have invested strongly over the past 2 years in building strong processes alongside investing in team growth and continue to build a diverse income portfolio for each programme.

Financial review

a. Going concern

In the last two years steps have been introduced to improve financial management in the charity, initially through creation of a COO role and reinforced by the creation of a finance and risk subgroup of the board which meets four times a year (a month before each board meeting). The remit of this group includes ensuring that the charity is a going concern and that the finances continue to improve. A report from this subgroup is reviewed at each board. We have also updated our financial management package and processes and the board receives much clearer information on our finances both restricted and unrestricted. These are now presented separately. Since this separation we have noted an improvement in the unrestricted finance figures.

Whilst reserve figures have not reached target amounts in 2024, the long-term restricted funding contracts alongside improved financial controls and commensurate improvements in unrestricted performance in the start of 2025 give confidence that the charity will remain a going concern up until at least October 2026.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

b. Reserves policy

Our goal in 2024 was to build 3 months of unrestricted costs as reserves. This was not reached in 2024 but the financial processes and decisions needed to get there were put in place along with realistic plans of how to build reserves. This work is bearing fruit in 2025 as we increased unrestricted funds by £120,000 in the first six months. Our 2025-26 goal is to hold a minimum of £133,000 (average one-month total CSH costs) and a target £150,000 (three months of unrestricted costs) in unrestricted reserves.

c. Deficit

This financial period (Jan 2024 – Dec 2024) the charity had an income of £1,279,455 and expenditure of £1,495,234 resulting in an operating deficit for the year amounting to £215,779.

At the close of December 2024, the charity had projected a surplus of £12,000. However, on completion of our Woodland Creation project in March 2025, there was a capital underspend of £227,845 for which a credit note was issued post year end. Our funders Defra confirmed this amount of capital funding received up front should not have been released at the start of the project, and therefore the capital underspend credit note has been accrued back into 2024 to show a true and fair view of the restricted fund balance as at 31 December 2024. As this return of income is related to a restricted fund, the accrual of this amount into 2024 does not affect our unrestricted funds position but does mean that the 2024 accounts as a whole show a loss.

The total equity held at the end of the reporting period were £213,532. Of these funds, £174,453 are held for restricted projects and £39,079 are held for general purposes.

d. Principal funding

The bulk of CSH’s funding has been in the form of restricted grants or contract funding which includes a contribution to the Charity’s overheads. CSH continues to increase its revenue sources from unrestricted funding through the expansion of its online CSH Sustainability School, delivering commissioned training and 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 worked to develop a corporate funding programme that enables companies aligned with our values and mission to support CSH’s work. This programme has been adapted during the year and is ready to be taken up by the fundraising team. Alongside this, we have worked to grow consultancy income across all of our programmes.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

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. A further update was made in December 2024.

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, twice online and twice in person, led by the Chair. The CEO 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.

We conducted a governance review with the Board in 2023 and worked on the identified areas in 2024. In 2024, we set up a new sub-committee for finance and risk management which meets quarterly before each Board meeting to review financial and other risks. This committee reports to the Board and also proposes any necessary changes to procedures or policies for this area.

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.

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.

Rachel Stancliffe resigned her position as a trustee in December 2024.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

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 has been put in place with a traffic light marking (red, amber, and green) to highlight projects at risk during any stage of their progress. The risk assessment for projects is reviewed quarterly 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. In 2025 we will continue to prioritise:

• In depth NHS Forest site development via expansion of the Nature Recovery Rangers Programme including green prescribing.

• Work on the concept of green space as a healthcare asset.

• Exploring the potential for green space to address health inequalities.

• Expanding the Tree Equity Score to new countries.

• Designing and developing a Green Space consultancy offer.

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

• Expand our work in Europe to develop sustainable specialties.

• Continue to promote The Green Ward Competition and Green Specialty Challenges.

• Develop the SusQI Academy and Beacon Site Programme.

• Work closely with partner organisations to achieve strategic change in key parts of the health system develop Green Plans.

• Continue to develop our training courses offering more courses and extending the reach of existing ones.

• Build international relationships with key partners that can extend the reach of all our work.

Our communications officers continue to help us to develop strong messaging and to design powerful campaigns which will increase our reach and impact. We have reviewed the need for more comms capacity and will replace our generalist comms lead with 2 part-time comms specialists from clinical and greenspace early next year.

In addition to specific programme funding, core funding for CSH is being sought from several grant making foundations. We have reviewed the need to bring in more fundraising capacity as we currently only have 0.6 FTE working directly on fundraising. We will increase this team with an additional full-time staff member in 2025.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

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 staff meetings and a staff survey and have been kept informed on specific matters directly by management. The company carries out exit interviews for all staff leaving the organisation and has adopted a procedure of upward feedback for senior management and the Trustees.

The company has implemented a number of detailed policies in relation to all aspects of personnel matters including:

• Equal opportunities policy

• Volunteers' policy

• Health & safety policy

In accordance with the company's equal opportunities policy, the company has long established fair employment practices in the recruitment, selection, retention and training of disabled staff.

In addition, in 2024 the whole team worked actively on EDI, including the development of an EDI action plan which will inform all aspects of our work including recruitment, retention, comms, events and everyday working practices.

Full details of these policies are available from the company's offices.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

TRUSTEES' REPORT (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2024

Statement of Trustees' responsibilities

The Trustees (who are also the directors of the company for the purposes of company law) are responsible for preparing the Trustees' report and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice).

Company law requires the Trustees to prepare financial statements for each financial year. Under company law, the Trustees must not approve the financial statements unless they are satisfied that they give a true and fair view of the state of affairs of the company and of its incoming resources and application of resources, including its income and expenditure, for that period. In preparing these financial statements, the Trustees are required to:

• select suitable accounting policies and then apply them consistently;

• observe the methods and principles of the Charities SORP (FRS 102);

• make judgments and accounting estimates that are reasonable and prudent;

• state whether applicable UK Accounting Standards (FRS 102) have been followed, subject to any material departures disclosed and explained in the financial statements;

• prepare the financial statements on the going concern basis unless it is inappropriate to presume that the company will continue in business.

The Trustees are responsible for keeping adequate accounting records that are sufficient to show and explain the company's transactions and disclose with reasonable accuracy at any time the financial position of the company and enable them to ensure that the financial statements comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the company and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

Disclosure of information to auditors

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

• so far as that Trustee is aware, there is no relevant audit information of which the charity's auditors are unaware, and

• that Trustee has taken all the steps that ought to have been taken as a Trustee in order to be aware of any relevant audit information and to establish that the charity's auditors are aware of that information.

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

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:

_________ Gill Manning (Acting Chair of Trustees) Date: 24-09-25

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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 31 December 2024 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:

• give a true and fair view of the state of the charitable company's affairs as at 31 December 2024 and of its incoming resources and application of resources, including its income and expenditure for the year then ended;

• have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice; and

• have been prepared in accordance with the requirements of the Companies Act 2006.

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.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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:

• the information given in the Trustees' report for the financial year for which the financial statements are prepared is consistent with the financial statements.

• the Trustees' report has been prepared in accordance with applicable legal requirements.

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:

• adequate accounting records have not been kept, or returns adequate for our audit have not been received from branches not visited by us; or

• the financial statements are not in agreement with the accounting records and returns; or

• certain disclosures of Trustees' remuneration specified by law are not made; or

• we have not received all the information and explanations we require for our audit; or

• the Trustees were not entitled to prepare the financial statements in accordance with the small companies regime and take advantage of the small companies' exemptions in preparing the Trustees' report and from the requirement to prepare a Strategic report.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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.

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;

• enquiries with the same of where there is susceptibility to fraud in 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.

• we focussed on the following laws and regulations that were considered to have a direct effect on the financial statements as identified as being significant to the entity, which 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;

• review of board minutes;

• review of funding agreements;

• testing the appropriateness of entries in the nominal ledger, including journal entries;

• reviewing transactions around the end of the reporting period;

• the performance of analytical procedures to identify unexpected movements in account balances which may be indicative of fraud or management bias.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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)

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.

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

Date: 25-09-25

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

(A company limited by guarantee)

STATEMENT OF FINANCIAL ACTIVITIES (INCORPORATING INCOME AND EXPENDITURE ACCOUNT) FOR THE YEAR ENDED 31 DECEMBER 2024

Note Income from: Donations and legacies 4 Charitable activities 5 Total income Expenditure on: Charitable activities 6 Total expenditure Net (expenditure)/income Transfers between funds 14 Net movement in funds Reconciliation of funds: Total funds brought forward Net movement in funds Total funds carried forward	Restricted funds 31 December 2024 £ 586,635 273 586,908 808,654 808,654 (221,746) 21,890 (199,856) 374,309 (199,856) 174,453	Unrestricted funds 31 December 2024 £ 55,620 636,927 692,547 686,580 686,580 5,967 (21,890) (15,923) 55,002 (15,923) 39,079	Total funds 31 December 2024 £ 642,255 637,200 1,279,455 1,495,234 1,495,234 (215,779) - (215,779) 429,311 (215,779) 213,532	Total funds 13 months ended 31 December 2023 £ 915,293 669,054
				1,584,347
				1,361,327
				1,361,327
				223,020 -
				223,020
				206,291 223,020
				429,311

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

The notes on pages 28 to 49 form part of these financial statements.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

BALANCE SHEET AS AT 31 DECEMBER 2024

Note Fixed assets Tangible assets 11 Current assets Debtors 12 Cash at bank and in hand Current liabilities 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	220,399 306,727 527,126 (317,699)	2024 £ 4,105 4,105 209,427 213,532 213,532 174,453 39,079 213,532	78,645 422,428 501,073 (81,368)	2023 £ 9,606
				9,606 419,705
				429,311
				429,311
				374,309 55,002
				429,311

Page 25

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

(A company limited by guarantee) REGISTERED NUMBER: 07450026

BALANCE SHEET (CONTINUED) AS AT 31 DECEMBER 2024

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:

................................................

Gill Manning (Acting Chair of Trustees) Date: 24-09-25

The notes on pages 28 to 49 form part of these financial statements.

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Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

THE CENTRE FOR SUSTAINABLE HEALTHCARE LIMITED

(A company limited by guarantee)

STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 DECEMBER 2024

Cash flows from operating activities Net cash used in operating activities Cash flows from investing activities Purchase of tangible fixed assets Net cash provided by/(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 28 to 49 form part of these financial statements	31 December 2024 £ (115,701) - - - (115,701) 422,428 306,727	13 months ended 31 December 2023 £ 130,958 (6,340) (6,340) - 124,618 297,810 422,428

Page 27

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

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 registered office is Suite 310, 266 Banbury Road, Summertown, Oxford, OX2 7DL.

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.

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 19.

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.

Expenditure on charitable activities is incurred on directly undertaking the activities which further the company's objectives, as well as any associated support costs.

Page 28

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

2. Accounting policies (continued)

2.4 Expenditure (continued)

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:

• Computer equipment 33% Straight Line

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.

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.

Page 29

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

2. Accounting policies (continued)

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 year.

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.

Designated funds comprise unrestricted funds that have been set aside by the Trustees for particular purposes. The aim and use of each designated fund is set out in the notes to the financial statements.

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.

Page 30

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

4. Income from donations and legacies

Donations Grants Total 2024 Donations Grants Total 2023	Restricted funds 31 December 2024 Unrestricted funds 31 December 2024 £ £ - 15,636 586,635 39,984 586,635 55,620 Restricted funds 13 months ended 31 December 2023 Unrestricted funds 13 months ended 31 December 2023 £ £ - 9,393 756,361 149,539 756,361 158,932	Total funds 31 December 2024 £ 15,636 626,619
		642,255
		Total funds 13 months ended 31 December 2023 £ 9,393 905,900
		915,293

Page 31

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

5. Income from charitable activities

Income from charitable activities - Clinical Income from charitable activities - NHS Forest Total 2024 Income from charitable activities - Clinical Income from charitable activities - NHS Forest Total 2023	Restricted funds 31 December 2024 Unrestricted funds 31 December 2024 £ £ - 549,731 273 87,196 273 636,927 Unrestricted funds 13 months ended 31 December 2023 £ 519,639 149,415 669,054	Total funds 31 December 2024 £ 549,731 87,469
		637,200
		Total funds 13 months ended 31 December 2023 £ 519,639 149,415
		669,054

Page 32

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

6. Analysis of expenditure on charitable activities

Summary by fund type

Clinical NHS Forest Total 2024 Clinical NHS Forest Total 2023	Restricted funds 31 December 2024 Unrestricted funds 31 December 2024 £ £ 427,796 596,730 380,858 89,850 808,654 686,580 Restricted funds 13 months ended 31 December 2023 Unrestricted funds 13 months ended 31 December 2023 £ £ - 755,197 369,033 237,097 369,033 992,294	Total 31 December 2024 £ 1,024,526 470,708
		1,495,234
		Total 13 months ended 31 December 2023 £ 755,197 606,130
		1,361,327

Page 33

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

6. Analysis of expenditure on charitable activities (continued)

Summary by expenditure type

Clinical NHS Forest Total 2024 Clinical NHS Forest Total 2023	Staff costs 31 December 2024 £ 813,498 320,703 1,134,201 Staff costs 13 months ended 31 December 2023 Depreciation 13 months ended 31 December 2023 £ £ 652,583 3,494 436,380 2,287 1,088,963 5,781	Other costs 31 December 2024 £ 211,028 150,005 361,033 Other costs 13 months ended 31 December 2023 £ 99,120 167,463 266,583	Total 31 December 2024 £ 1,024,526 470,708 1,495,234 Total 13 months ended 31 December 2023 £ 755,197 606,130 1,361,327

Page 34

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

7. Analysis of expenditure by activities

Clinical NHS Forest Total 2024 Clinical NHS Forest Total 2023	Activities undertaken directly 31 December 2024 £ 957,003 437,789 1,394,792 Activities undertaken directly 13 months ended 31 December 2023 £ 706,600 540,590 1,247,190	Support costs 31 December 2024 £ 67,523 32,919 100,442 Support costs 13 months ended 31 December 2023 £ 48,596 65,541 114,137	Total funds 31 December 2024 £ 1,024,526 470,708
			1,495,234
			Total funds 13 months ended 31 December 2023 £ 755,196 606,131
			1,361,327

Page 35

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

7. Analysis of expenditure by activities (continued)

Analysis of direct costs

Staff costs Project costs Project partner costs Project publications, leaflets and maps Professional and consultancy Website and computer costs Travel and subsistence Conference costs Sub-contractors costs Total 2024	Clinical 31 December 2024 £ 813,498 49,822 40 210 - 2,220 15,486 876 74,851 957,003	NHS Forest 31 December 2024 £ 320,705 99,136 800 16 825 - 7,553 5,246 3,508 437,789	Total funds 31 December 2024 £ 1,134,203 148,958 840 226 825 2,220 23,039 6,122 78,359
			1,394,792

Page 36

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

7. Analysis of expenditure by activities (continued)

Analysis of direct costs (continued)

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-contractor costs Total 2023	Clinical 13 months ended 31 December 2023 £ 652,583 - 28,083 43 15,400 - - 40 1,383 - 7,219 1,850 706,601	NHS Forest 13 months ended 31 December 2023 £ 436,380 226 94,778 44 - 3,313 857 32 1,295 47 2,450 1,167 540,589	Total funds 13 months ended 31 December 2023 £ 1,088,963 226 122,861 87 15,400 3,313 857 72 2,678 47 9,669 3,017
			1,247,190

Page 37

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

7. Analysis of expenditure by activities (continued)

Analysis of support costs

Website and network costs Travel and subsistence Printing, postage and stationery Office expenses Bookkeeping Entertainment Telephone Miscellaneous Bank charges Rent Insurance Payments to charitable parties Training Foreign exchange difference Depreciation Governance costs Total 2024	Clinical 31 December 2024 £ 23,886 5,264 501 7,237 7,876 1 69 4,541 295 1,163 2,421 499 104 25 2,751 10,890 67,523	NHS Forest 31 December 2024 £ 8,355 2,615 160 3,036 7,169 - 54 1,228 91 469 1,317 56 8 - 2,751 5,610 32,919	Total funds 31 December 2024 £ 32,241 7,879 661 10,273 15,045 1 123 5,769 386 1,632 3,738 555 112 25 5,502 16,500
			100,442

Page 38

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

7. Analysis of expenditure by activities (continued)

Analysis of support costs (continued)

Clinical 13 months ended 31 December 2023 £ Depreciation 3,494 Website and network costs 8,221 Travel and subsistence 10,099 Printing, postage and stationery 485 Office expenses - Telephone 221 Miscellaneous 2,057 Bank charges 464 Insurance 732 Payments to charitable parties 1,486 Training 6,050 Governance costs 15,287 Total 2023 48,596 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 13 months ended 31 December 2023 £ 2,061 32,831 8,130 588 1,222 213 3,791 306 733 175 203 15,288 65,541 31 December 2024 £ 9,000 22,410	Total funds 13 months ended 31 December 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
		13 months ended 31 December 2023 £ 7,000 23,575

8. Auditors' remuneration

Page 39

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

9. Staff costs

Wages and salaries Social security costs Contribution to defined contribution pension schemes	31 December 2024 £ 985,655 93,313 55,233 1,134,201	13 months ended 31 December 2023 £ 956,972 81,790 50,201
		1,088,963

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

Trustee Administration	31 December 2024 No. 1 31 32	13 months ended 31 December 2023 No. 1 25
		26

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

The total remuneration and benefits (including employers pension contribitions) received by the key management personel was £105,707 (2023 - £117,325).

Page 40

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

10. 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:

			13 months
			ended
		31	31
		December	December
		2024	2023
		£	£
	Remuneration and pension
Rachel Stancliffe	contributions	60,049	62,661

During the year ended 31 December 2024, expenses were reimbursed or paid directly to 2 Trustees (2023 - to 1 Trustee) broken down as follows:

		13 months
		ended
	31	31
	December	December
	2024	2023
	£	£
Travel, Subsistence, and Meeting Costs	974	533

Page 41

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

11. Tangible fixed assets

Cost or valuation At 1 January 2024 At 31 December 2024 Depreciation At 1 January 2024 Charge for the year At 31 December 2024 Net book value At 31 December 2024 At 31 December 2023	Office equipment £ 21,670
	21,670
	12,064 5,501
	17,565
	4,105
	9,606

Page 42

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

12. Debtors

Due within one year Trade debtors Other debtors Prepayments and accrued income Creditors: Amounts falling due within one year Trade creditors Other taxation and social security Other creditors Accruals and deferred income Deferred income at 1 January 2024 Amounts released from previous periods	2024 £ 127,089 90,819 2,491 220,399 2024 £ 21,814 47,799 841 247,245 317,699 2024 £ 23,571 (23,571) -	2023 £ 36,779 38,280 3,586 78,645 2023 £ 1,051 33,303 9,463 37,551 81,368 2023 £ 153,615 (130,044) 23,571

13. Creditors: Amounts falling due within one year

No income was deferred as at 31 December 2024 as there was no money that was received in advance for projects delivered over a timeframe which partly related to the following accounting period.

Page 43

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

14. Statement of funds

Statement of funds - current year

Unrestricted funds Designated funds Microtech Sponsorship General funds General Funds Total Unrestricted funds Restricted funds EU Horizon HF Living Donor Q Project Sport England UK Kidney project SBRI Woodland Creation Tree Call To Action Total of funds	Balance at 1 January 2024 £ - 55,002 55,002 - - - - - - 376,403 (2,094) 374,309 429,311	Income £ 20,000 672,547 692,547 291,075 45,176 35,871 3,000 53,075 99,910 (99,531) 158,332 586,908 1,279,455	Expenditure £ (5,000) (681,580) (686,580) (293,980) (19,133) (17,218) (2,225) (11,374) (86,087) (195,717) (182,920) (808,654) (1,495,234)	Transfers in/out £ - (21,890) (21,890) - - - - - - - 21,890 21,890 -	Balance at 31 December 2024 £ 15,000 24,079 39,079 (2,905) 26,043 18,653 775 41,701 13,823 81,155 (4,792) 174,453 213,532

Page 44

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

14. Statement of funds (continued)

The SBRI restricted fund relates to funding from SBRI for a project investigating environmental sustainability and equity in maternity care. This 12-month project was in partnership with the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the Sustainable Healthcare Coalition with funding going on staff costs, a fellowship and patient and public involvement.

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 Trees Call To Action restricted fund relates to funding from National Lottery Heritage Fund (NLHF) on behalf of DEFRA. The funding is to be spent on activities including; training in tree planting and green space improvement for NHS staff and volunteers to support tree planting on NHS sites, 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 project activities.

The EU Horizon new fund is part of a 4-year European-wide project to transform kidney care. This multipartner project involves pilot sites in 4 European countries. Costs include staff time and travel, as well as translation services and cost of delivering education courses to upskill the renal workforce. Funding is distributed through UKRI.

The HF Living Donor new fund is a Health Foundation funded project which is investigating how the Living Kidney Donor pathway can be made more sustainable through working with pilot sites and NHS Blood and Transplant.

The Q Project new fund is funded by the Health Foundation and is investigating the cost of medicines waste in care homes in the UK. The grant is being spent on staff to deliver the project and costs for partner organisations who are acting as test sites.

The Sport England new fund is delivering green health routes to encourage and facilitate access to existing Forestry England green spaces through signage, guided walks and community engagement. This project is funded by Sport England and Forestry England. Costs include staff time and project materials.

The UK Kidney project new fund is funded by the Greener NHS and sees a partnership approach to embedding sustainability in UK kidney care.

Page 45

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

14. Statement of funds (continued)

Statement of funds - prior year

Unrestricted funds General Funds Restricted funds SBRI Woodland Creation Tree Call To Action Total of funds	Balance at 1 December 2022 £ 219,309 (8,861) - (4,157) (13,018) 206,291	Income £ 827,986 92,984 471,700 191,677 756,361 1,584,347	Expenditure £ (992,293) (84,123) (95,298) (189,613) (369,034) (1,361,327)	Balance at 31 December 2023 £ 55,002 - 376,402 (2,093) 374,309 429,311

Page 46

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

15. Summary of funds

Summary of funds - current year

Designated funds General funds Restricted funds	Balance at 1 January 2024 £ - 55,002 374,309 429,311	Income £ 20,000 672,547 586,908 1,279,455 Balance at 1 December 2022 £ 219,309 (13,018) 206,291	Expenditure £ (5,000) (681,580) (808,654) (1,495,234) Income £ 827,986 756,361 1,584,347	Transfers in/out £ - (21,890) 21,890 - Expenditure £ (992,293) (369,034) (1,361,327)	Balance at 31 December 2024 £ 15,000 24,079 174,453
					213,532
					Balance at 31 December 2023 £ 55,002 374,309
Summary of funds - prior year
General funds Restricted funds
					429,311

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 2024 Unrestricted funds 2024 £ £ - 4,105 174,453 352,673 - (317,699) 174,453 39,079	Total funds 2024 £ 4,105 527,126 (317,699)
		213,532

Page 47

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

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 2023 £ - 374,310 - 374,310	Unrestricted funds 2023 £ 9,606 126,763 (81,368) 55,001	Total funds 2023 £ 9,606 501,073 (81,368) 429,311

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

Net income/expenditure for the period (as per Statement of Financial Activities) Adjustments for: Depreciation charges Decrease/(increase) in debtors Increase/(decrease) in creditors Net cash provided by/(used in) operating activities Analysis of cash and cash equivalents Cash in hand Total cash and cash equivalents	2024 £ (215,779) 5,501 (141,754) 236,331 (115,701) 2024 £ 306,727 306,727	13 months ended 2023 £ 223,020 5,780 37,874 (135,716) 130,958 2023 £ 422,428 422,428

18. Analysis of cash and cash equivalents

Page 48

Docusign Envelope ID: 46A2F624-FFAF-4ACF-B81D-1BBB1533BE89

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

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2024

19. Analysis of changes in net debt

Cash at bank and in hand	At 1 December 2023 £ 422,428 422,428	Cash flows £ (115,701) (115,701)	At 31 December 2024 £ 306,727
			306,727

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 £55,233 (2023 - £50,201).

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 Jessica Rhys-Griffith, amounting to £nil in respect of consultancy services (2023 - £12,786).

Page 49