Sustainability

Supported by annual delivery plan 3: Ensuring Sustainability

Ensuring our services are sustainable for the future is essential to delivering high-quality care. In 2025/26, we focused on improving productivity, strengthening our financial position, investing in digital technology and reducing our environmental impact.  

Financial sustainability

We delivered a strong financial performance during the year.

• We achieved a £1.9 million surplus, supported by national funding and careful financial management
• We delivered £24.9 million in cost improvements, with 65% of these recurring, helping to strengthen our long-term position
• Our underlying deficit improved from £8.5 million to £3.6 million, reflecting sustained progress in managing our costs

Our organisation must remain financially sustainable to ensure that it continues to provide safe, high quality mental health care for our communities across our five boroughs now, and in the future.  

·        Overall position: £1.9m net surplus retained (after adjusting for impairments)

·        Cash: £44m planned cash reserves are required in future years to partly fund the Better Environments programme

·        Income £380m income this year

·        Expenditure: £379m

o   Employee expenses £260m

o   Premises £15m

o   Supplies and services £11m

o   Depreciation £12m

o   Purchase of healthcare £66m

o   Drugs £2m

o   Other £13m

·        Capital investments: £58.8m

o   Better Communities programme £52m

o   Technology £3m

o   Maintenance £4m

·        Savings programme: 24.9m

 

Our financial statements can be found from pages 128 onwards which comply with our regulatory requirements.  

Financial position

This year we are reporting a deficit of £0.7m; this includes downward revaluation of Trust assets due to market revaluation.  Impairments of this nature are technical our financial performance is measured against the position excluding impairments; a £1.9m surplus.  

The table below summarises our financial performance for the year. Impairments are reported within operating costs and, as explained above, are deducted to get to the position before impairments referred to as the Net Retained Surplus for the Year.

This position was better than planned and alongside some unplanned income received from NHS England, is representative of strong operational success in delivering challenging cost improvements alongside high levels of inpatient demand. 

In addition, we delivered against the Department of Health and Social Care (DHSC) targets set out below:

ü   Operate within a Capital Resource Limit of £58.8m

ü   Maintain a Capital Cost Absorption rate of 3.5%

 Income

Total income received in the year ended 31 March 2026 was £380.4m (£352.9m in 2024/25), with 96% coming from patient care activities. The significant majority (81%) of non-patient care income related to education, training and research. 

A breakdown of total income is shown below:

·        NHS South West London ICB: £276m

·        NHS England £29m

·        Other NHS providers: £51m

·        Other income from activities £8m

·        Education, training and research £13m

·        Other nonpatient related income £3m

 Donations

The Trust continues to operate an official charity and is grateful for all the support it receives. The Trust Charity is a member of NHS Charities Together, who following generous donations from the public during the pandemic allocated grants to individual NHS charities. The Trust charity is not consolidated into the Trust’s accounts but reported upon separately.

 Expenditure

We spent £379.9m (£349.5m in 2024/25) on operating expenditure (excluding impairments) during the year. The emphasis has remained one of utilising this resource as efficiently as possible whilst maintaining and improving quality. 

The most significant area of expenditure is staffing which accounted for £260m (£233.7m in 2024/25) or 68% (67%) of the total. This expenditure includes salaries and employers’ pension and national insurance contributions as well as contributions to the Apprenticeship Levy. Only with high quality and motivated staff can we deliver our high quality services. We continue to develop strategies to recruit, train and retain staff to ensure that high quality services are first maintained and then improved.  

Payments to Creditors

We are committed to paying our creditors promptly and have signed up to the Better Payment Practice Code.  The code requires us to aim to pay undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later. We paid 96.6% (in terms of value) of non-NHS invoices within this period (96.2% in terms of number) and 98.7% of NHS invoices (in terms of value) within this period, 91.4% in terms of number. 

Strong Cash Position

Our cash balance of £44m remains at a healthy level and will be used to fund Better Environments and support servicing of our loan. We had a £99m loan from the Department of Health and Social Care to partly fund the construction costs of our new hospitals.  Repayments of the loan are due to commence in 2027/28 funded by cash from asset sales. 

Capital Investment Programme

During the year, we invested £58.8m in capital schemes.  These are schemes to acquire, upgrade or maintain physical assets such as buildings and equipment.  The high value of investment primarily reflects the Better Environments programme.  More than 88% of our capital expenditure in the year was spent on Better Environments.  

Having previously completed two hospitals on the Springfield site, focus is now on the development of the Tolworth and Barnes sites. We are grateful for the additional funding we received to contribute to improvements at Springfield, to progress the development at Barnes, to make our sites more environmentally sustainable, and to improve our IT infrastructure. A summary of the capital investments is shown in the following table:

Improving productivity

Improving productivity is an important part of delivering sustainable services and ensuring we provide high-quality care to as many people as possible. Throughout the year, we focused on making better use of our workforce, reducing waste, improving efficiency and supporting better outcomes for patients. 

Workforce stability improved through lower vacancy rates, reduced turnover and continued investment in recruitment, retention and staff development. More stable teams have improved continuity of care, reduced pressure on services and supported better patient outcomes. 

We also strengthened workforce planning through improved job-planning processes and new digital systems, helping improve oversight, consistency and the effective use of clinical time. Alongside this, we continued to reduce administrative burden through digital improvements and the use of robotic process automation within finance services, with further opportunities identified across corporate functions. 

These improvements contributed to measurable gains in productivity. NHS England reporting showed our productivity improved by 5.2%, compared with a peer median of 3.2%, while our national cost index also improved. We made significant progress in reducing length of stay, an area previously identified as an outlier, achieving the greatest improvement of any mental health provider in London. We also reduced our Did Not Attend (DNA) rate from more than 7% to 5.8%, compared with a peer median of 8.5%, helping more people receive care when they need it. 

While this progress is encouraging, we recognise there is more to do. Over the coming year, we will continue focusing on improving flow through services, reducing delays for patients who are clinically ready for discharge, further reducing DNA rates and ensuring staff have meaningful, up-to-date job plans that support high-quality, efficient care. 

Using digital to improve care and efficiency

Through the Better Digital programme, we continued to strengthen how digital technology supports safe, effective and compassionate care. Our digital work continued to be organised into four core themes: 

•        Digitally empowered patients: We made further progress in improving patient access to digital records and information, supporting greater ownership of care. Hybrid models of care were expanded, enabling an appropriate balance between face-to-face and digital support if preferred. We continue to develop our services with inclusion and accessibility at their core, helping to reduce barriers to access and support continuity of care across services and settings. During the year we started our Patient Engagement Portal (PEP) implementation which is planned to go live in mid-2026 – this will take us on out first step towards integrating with the NHS App and providing greater access for patients to their records.

•        Digitally enabled employees: We focused on enabling staff to work efficiently from any location using reliable, fit-for-purpose digital tools. We have been working to reduce our administrative burden through workflow optimisation and automation, freeing up time for care. Targeted digital training and the continued development of Digital Champions strengthened confidence, capability and adoption across teams, while consistent digital ways of working continue to be embedded. This year we initiated pilots of some proven Ambient Voice Technologies (AVT), to understand what works best for our patients and clinicians; this AI based technology will support more focussed face to face clinician-to-patient discussion improving patient experience and reduce the time taken to write up notes freeing up clinical time to support those that need our specialist support.

•        Interoperable and intelligent systems – digitised pathways: We continued to optimise core clinical and corporate systems around sensible, user‑led workflows rather than technological constraints. Interoperability and data flow across services and partners were improved, reducing duplication and better use of data continues to support clinical, operational and managerial decision-making, helping teams deliver more coordinated and efficient care. To improve results reporting, this year, we have worked with other local providers to enable the digital receipt of pathology results to improve patient care; this we anticipate to go live in 2026. The trust has also piloted some exciting emerging technology within both the Extended and Virtual reality areas to support the treatment of patients and help them cope with fears and phobias that affect their daily lives.

•        Supportive infrastructure – digital inclusion and cyber security: In terms of our IT systems, we continue to maintain high-performing, resilient infrastructure across inpatient and community settings. Cyber resilience and assurance were strengthened, alongside contingency plans in the event of IT incidents. We also continue to progress IT infrastructure developments to support digital inclusion for both staff and patients, ensuring access to digital services is safe, reliable and equitable. 

This work has supported us to improve our digital maturity, electronic patient record usability and data protection security toolkit scores and ratings during the year all of which have kept us moving forward along our digital journey. 

Looking ahead, we will continue to build on these foundations, focusing on further automation, improved interoperability, strengthened cyber resilience and the use of advanced analytics and AI to support staff and improve outcomes for patients. 

Improving environmental sustainability

We continued to take steps to reduce our environmental impact and support the NHS commitment to net zero.

This included:

• reducing carbon emissions across our estate by improving energy use and transitioning to greener electricity
• investing in sustainable infrastructure, including solar energy and electric vehicle charging
• reducing waste, including cutting single-use items and improving recycling
• embedding sustainability into clinical practice and decision-making

 We also strengthened staff engagement in sustainability through training and behaviour change initiatives, supporting a culture of environmentally responsible working. 

Environmental sustainability and climate-related financial disclosures

Environmental sustainability is a key part of delivering high-quality, future-proof healthcare. Climate change presents risks to our patients, staff and services, particularly for the most vulnerable communities, and we are committed to reducing our environmental impact while strengthening resilience. 

Our approach is set out in our Green Plan (2021–2026), which aligns with national NHS commitments to reach net zero:

• We aim to reach net zero for emissions we directly control by 2040, with an ambition to achieve an 80% reduction by 2028–2032
• For emissions we can influence, we aim to reach net zero by 2045, with an ambition to achieve an 80% reduction by 2036–2039

 

Task Force on Climate-related Financial Disclosures (TCFD)

We are implementing the requirements of the Task Force on Climate-related Financial Disclosures (TCFD) to ensure that climate-related risks and opportunities are understood, managed and reported transparently. 

Metrics and Targets

We use a combination of national NHS metrics and locally defined key performance indicators to monitor progress against its climate objectives and to manage climate‑related risks and opportunities. 

Carbon emissions are reported in tonnes of carbon dioxide equivalent (tCO₂e) and classified in line with the Greenhouse Gas Protocol across Scope 1 (direct), Scope 2 (energy indirect) and relevant Scope 3 categories. Emissions data is derived from national NHS reporting systems and supplemented by local operational metrics. We are committed to achieving:

·        Net zero for NHS Carbon Footprint (Scopes 1 and 2) by 2040, with an interim ambition of an 80% reduction by 2028–2032.

·        Net zero for NHS Carbon Footprint Plus (Scope 3) by 2045, with an 80% reduction ambition by 2036–2039.

 Progress to date includes a 7.3% reduction in carbon emissions over five years, a 24.1% reduction in gas consumption, and delivery of emissions reductions through estates transformation despite increased electricity demand associated with modern, energy‑intensive clinical environments supplied on green tariffs. 

In addition to long‑term net zero targets, we have established intermediate quantitative milestones to demonstrate delivery, including:

• Installation of onsite renewable energy generation from 2026/27.
• Delivery of funded decarbonisation schemes including solar PV, LED lighting and EV infrastructure.
• Quarterly monitoring of estate‑related carbon reductions.
• Expansion of sustainable procurement through the NHS Evergreen framework.
• Delivery of climate adaptation actions informed by a comprehensive climate risk assessment.

These metrics and targets are monitored through the Green Plan Delivery Group and reported through existing governance and assurance arrangements, supporting Board‑level oversight of climate‑related risks and opportunities in line with DHSC Group Accounting Manual and TCFD expectations. 

Governance

We recognise climate change as a significant strategic and operational risk. Climate-related risks are managed through our existing governance, risk management and assurance processes, with oversight provided through our Green Plan and Better Communities Programme. 

Accountability is supported through regular reporting to senior leadership and the Board. To strengthen our approach further, we are establishing a Climate Adaptation Lead role to coordinate climate risk assessment, oversee adaptation planning and support Board-level assurance. 

We are also working closely with local authorities and partners across South West London to strengthen system-wide approaches to climate resilience, recognising that risks such as extreme weather and infrastructure disruption extend beyond organisational boundaries. 

Strategy and climate risks

We have identified a range of climate-related risks that could affect our services over the short, medium and long term. 

Physical risks include:

• extreme heat, affecting patient safety, staff wellbeing and estate performance
• severe weather, impacting access to services and infrastructure
• overheating in older buildings
• disruption to critical infrastructure, including power and digital systems 

Transition risks include:

• increasing regulatory and reporting requirements
• financial pressures linked to energy costs and capital investment
• the need to adapt clinical models of care, procurement and travel
• reputational risks linked to sustainability performance 

These risks are being addressed through our Green Plan workstreams, including:

• clinical models of care
• procurement
• estates and facilities
• travel and transport
• adaptation and resilience
• education and engagement 

This work is delivered in partnership with the wider South West London system, supporting coordinated and place-based approaches. 

Risk management

Climate-related risks are currently identified and managed through existing processes, including:

• emergency preparedness and business continuity planning
• our Severe Weather Plan
• regional intelligence, including the London Risk Register 

We are strengthening our approach by:

• completing a comprehensive climate risk assessment
• integrating climate risks into our corporate risk management framework
• improving the use of data and scenario analysis to inform planning 

Mitigation actions include:

• improving estate resilience and infrastructure
• sustainable service redesign
• ongoing monitoring through Green Plan performance measures 

Springfield and Tolworth hospitals from 2026 — 2027.

Delivering our Green Plan priorities

We have made progress across all of our priority areas during 2025/26, including:

• increasing the proportion of suppliers meeting sustainability standards
• reducing energy use and carbon emissions across our estate
• improving waste management, including food waste reduction and recycling
• expanding sustainability training and awareness across the workforce 

We also secured £811k in green funding to support solar panels, LED lighting and electric vehicle infrastructure. 

Improving sustainability through innovation and engagement

We have continued to embed sustainability into everyday practice through quality improvement and staff engagement.

This includes:

• introducing sustainability-focused quality improvement projects, such as reducing single-use items and improving clinical practice
• reducing medicine waste, with over £100k of medicines returned for reuse
• trialling new approaches to care that reduce environmental impact, including long-acting treatments 

We have also supported behaviour change through initiatives such as:

• a “Lights Off” campaign to reduce energy use
• reducing single-use plastics through a Trust-wide mug campaign
• establishing a Green Champions network across clinical and corporate teams

Going Concern

We are required to consider whether it is appropriate for our accounts to be prepared on a ‘going concern’ basis. The going concern assumption is a fundamental principle in the preparation of financial statements, under which an entity is ordinarily viewed as continuing in business for the foreseeable future. 

NHS organisations by their nature are considered a going concern. Our plan to continue providing services in the public sector is documented in our published strategy.  Nationally there is continued investment in mental health services, and we are working with partners in relation to the investments and transformation required. 

After making enquiries, the directors have a reasonable expectation that the services we provide will continue to be provided by the public sector for the foreseeable future and for this reason have adopted the going concern basis in preparing the accounts, following the definition of going concern in the public sector adopted by HM Treasury’s Financial Reporting Manual.

Financial Outlook for 2026/27

The financial outlook for the NHS in 2026/27 remains challenging. Demand for services continues to grow, while the wider health and care system is undergoing significant change nationally, regionally and locally.

Across the NHS, reforms continue following publication of the Government’s 10-Year Health Plan for England, including changes to NHS England, Integrated Care Boards and the development of integrated neighbourhood health and care models. These changes place increasing emphasis on prevention, digital, partnership working and delivering more care closer to home.

We are already progressing many of these priorities. We continue to work closely with NHS, local authority and voluntary sector partners as financial pressures across the wider system continue to affect service delivery. Rising demand, workforce pressures and increasing patient complexity continue to create operational and financial challenges across mental health services and the wider system.

Despite these pressures, we remain focused on improving care quality, reducing restrictive care and supporting more people to receive treatment closer to home. In 2026/27, this will include the opening of Maple Ward, a new acute inpatient ward at Springfield University Hospital. The ward will operate with a shorter-stay therapeutic model designed to improve patient flow and reduce reliance on external beds.

We will also continue to build on progress made through the Adult Patient Journey programme, which has already helped reduce average length of stay to 63 days. Our focus remains on supporting timely discharge, improving patient flow and ensuring care is delivered in the least restrictive setting possible.

Significant changes are also planned within our Deaf mental health services. Following extensive engagement with NHS England, clinical partners, Deaf stakeholders and local commissioners, our national Deaf inpatient service (Corner House) will transfer into enhanced community-based Deaf mental health services across the region and nationally, supporting a more modern and community-focused model of care.

It is worth noting that last April, NHSE Specialised Commissioning department delegated the budgets for these services to local ICBs. We will continue to work to continue improving delivery. In parallel, we work actively with NHSE Specialised Commissioning on a range of directly commissioned items.

In 2026/27 Phase 3 of the Complex Care Programme is planned to roll out. This extends the programme’s scope to include a new cohort of SWL patients with Learning Disability and other conditions. This represents another increase in the overall Trust funding position.

We along with NHS South West London, continue to prioritise any available investment from the Mental Health Investment Standard (MHIS) and System Development Funding (SDF) in key services, including Home Treatment Teams, inpatient psychology and CAMHS emergency care support delivered within emergency departments.

As in previous years, the Trust is required to deliver a significant Cost Improvement Programme to support financial sustainability. Following delivery of £25 million of savings in 2025/26, the target for 2026/27 is £15 million. A key part of this work will continue to focus on quality improvement thought reducing length of stay, improving productivity through digital and reducing reliance on costly external placements.

We will also continue investing in modern environments and digital innovation. During 2026/27, we will open refurbished facilities at Richmond Royal, continue redevelopment work at Barnes Hospital and progress the redevelopment of Tolworth Hospital, with completion planned in 2027. Investment in digital services and emerging technologies, including artificial intelligence, will also continue to support both staff and patient care.

While the year ahead will remain challenging, we will continue working with staff, patients, carers and partners to improve quality, reduce inequalities and deliver sustainable mental health services for the communities we serve.

Looking ahead

Maintaining strong financial stewardship will remain essential as we respond to increasing demand, workforce pressures and wider NHS change. Our focus will continue to be on improving quality and productivity together, reducing unwarranted variation and making the best use of our resources – particularly reducing length of stay and use of Bank staff. We will continue investing in digital technology to help reduce administrative burden, improve efficiency and support better clinical and operational decision-making. Environmental sustainability will also remain a growing priority, with continued investment in greener infrastructure, more sustainable ways of working and reducing the environmental impact of our services.