Inspiration to get started

Here are some sustainability initiatives others have introduced to their practice which have made a difference.

Name of project

How we planted 1,000 trees in 3 days.

Where it took place


Project description

In April 2021, volunteers and patients planted in just 3 days a total of 1,000 trees across four of CNTW’s hospital sites (St George’s Park in Morpeth, Carleton Clinic in Carlisle, Hopewood Park in Sunderland, and St Nicholas Hospital in Newcastle) as part of the NHS Forest.

What prompted it? 

CNTW became the first mental health and disability trust to declare a Climate Emergency in 2020.

The Trust wanted to continue moving towards its goal of achieving Net Zero by 2040.

The Trust were aware of NHS Forest which is run by the Centre for Sustainable Healthcare (CSH) and is able to supply trees fully funded by the Green Recovery Challenge Fund.

What was implemented? 

CNTW signed up with NHS Forest and registered individual sites available for tree planting. A bid was sent to NHS forest and as part of this application, specific trees had to be requested from a list provided, as well as a Tree Agreement completed.

Sites also had to be identified and this was done with the support of the Estates / Grounds & Gardens team as well as a local ecologist. In total, 1,000 fully funded trees (with canes and tree guards) were supplied by the NHS Forest. In April 2021, volunteers and patients planted, in just 3 days, a total of 1,000 trees across four of CNTW’s hospital sites (St George’s Park in Morpeth, Carleton Clinic in Carlisle, Hopewood Park in Sunderland, and St Nicholas Hospital in Newcastle) as part of the NHS Forest.

What benefits were achieved?

Once mature, the 1,000 trees have the potential to absorb twenty-one tonnes of carbon from the atmosphere every year, as well as providing a habitat for biodiversity across the sites and creating wildlife corridors to connect existing planted areas.

They will also play a role in supporting the wellbeing of staff and service users; screening eyesores such as car parks, providing shade and a space to connect with nature, and contributing to the walking routes that exist on three of the four sites to promote exercise and relaxation.

The trees will form part of the broader development of green space throughout the sites, where ongoing activities currently include polytunnels and allotments used for occupational therapy activities.

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Name of project

From Plot to Perfect Poo

Where it took place

Anxiety Disorders Residential Unit,  South London and Maudsley NHS Foundation Trust

Project description

The Anxiety Disorders Residential Unit is a specialist service for treating severe obsessive compulsive and related disorders.

Our project puts sustainability at its heart. We are set in open green space where we have created an allotment for residents.

They receive support to grow and cook produce and source local ingredients for everyday eating. A new hospital café run by residents is also being developed. Food at the planned café, called Guts, enhances gut microbiota and promotes the importance of a healthy gut to mental health. The project empowers residents and promotes a culture of belonging.

What prompted the initiative?

Residents and staff were dissatisfied with the quality of the food provided by the hospital. Residents also often lacked motivation, knowledge or skills to cook gut friendly foods.

We wanted our unit to radicalise eating by becoming self-sufficient, improving the quality of food offered to residents and enhancing residents’ cooking skills.

We also wanted to use the project to disseminate knowledge about the effects of good gut health on mental health and to continue to explore ways of integrating local green space into the unit’s mental health care.

What was implemented?

All members of the team, residents and some ex-residents were involved in developing the project.

Funding was obtained and regular meetings held to discuss challenges e.g. adherence to infection control and ligature risks.

We obtained equipment and training from the local community. We incorporated shared tasks associated with growing, preparing and cooking food into “exposure” therapy as residents often find them very challenging.

We grew vegetables from seed and planted perennial fruits and vegetables. Residents were taught horticultural skills.

Our resident-led café, GUTS, will serve these foods as well as educate fellow staff and patients in the hospital about a gut healthy diet. Residents rotate roles within the community (for example gardening, washing up after dinner or serving in the GUTS café). Ongoing use of these skills is expected on discharge and we encourage residents to plan how they will do this.

What was the outcome?

Exact figures are as yet unknown. After COVID, we will be able to determine the exact amount of financial savings from not using the hospital-contracted caterer; the reduction of our carbon footprint from using local ingredients and growing our own food; the reductions in amount of wasted food and packaging from not using the contractor and take-aways that were previously ordered by residents.

There has been a high degree of satisfaction and positive feedback by residents for the project.

The service is non-hierarchical, and three residents have now been employed by the unit – for example one ex-resident is now employed as an assistant psychologist, one will be employed to manage the café, and another is employed as a housekeeper and horticulturalist. Change does not end at discharge: last year some residents went on to train as a chef or to work in hospitality.

Name of project

Connecting With Telehealth to Children in Hospital & Healthcare (CWTCH)  

Where it took place

Ty Bryn, St Cadocs Hospital, Newport

Project description

CWTCH is an NHS telepsychiatry project in CAMHS, Aneurin Bevan University Health Board (ABUHB) which offers virtual appointments to young people.

CWTCH gained recognition for its highly beneficial and suitable use across a range of CAMHS teams and have demonstrated high levels of satisfaction, significant savings and impressive outputs.

What prompted the initiative?

In a county with significant rurality, attending CAMHS can involve significant travel, time and carbon costs.

Telepsychiatry can significantly reduce costs and improve clinical efficiency and outcomes.

The CWTCH project, which is embedded within CAMHS, has built upon existing evidence demonstrating high-satisfaction of telepsychiatry, and has tackled barriers such as staff reluctance and technological challenges.

CWTCH has tested the suitability of using telepsychiatry in different CAMHS contexts, as well as measuring carbon footprint, patient satisfaction and cost and time savings for both patients and clinicians.

The CWTCH project has led to adoption of telepsychiatry into routine care.  

What changes were implemented?

  • From design, implementation and scale-up plans, the core team worked closely with CAMHS staff and had ‘CWTCH Champions’ at management level to help encourage telepsychiatry within their departments. CWTCH also had an efficient administration system in place, with dedicated secretaries involved in appointments and room bookings.

    CWTCH had a dedicated room named ‘The Attend Anywhere Room’ which had a booking system and training facilities. There were also four other rooms (operated as hot-desks if needed) which are considered ‘CWTCH Friendly Rooms’.

  • CWTCH has enabled the CAMHS Liaison Emergency team to provide a novel postvention telepsychiatry clinic on a Tuesday morning to schools.

    This involves the teachers alongside the affected young person and carers, therefore enabling delivery of individual assessments but also support to schools.

    This has also skilled up teaching staff in supporting other young people in their schools. 

What benefits were achieved?

  • There were significant cost and time savings. By combining the time of 257 people across 66 staff meetings and patient appointments, this saved 138 hours of clinician time, £2,804 in travel expenses and C02 savings of 1.65 tonnes (compared to usual practice).
  • Based on the high level of satisfaction, and the reported suitability from patients, families and clinicians, CWTCH has demonstrated high clinical and personal value too. 79% reported they were very satisfied with the video appointment and 70% said they’d very likely use it again and / or recommend to others.
  • Previously, owing to resource limitations, CAMHS liaison would have rejected most of the school referrals as not meeting threshold criteria, which would have led to a subsequent increase in crisis referrals. By reaching out efficiently and offering the postvention intervention to schools which have experienced tragic events, there has been a preventative ripple-effect.  

Name of project

Social change - improving air pollution

Where it took place

Southern Health NHS Foundation Trust

Project description

The Trust’s Chief Medical Officer called for volunteers in the organisation to help reduce local air pollution for the population we serve.

The teams implemented a number of initiatives including changes to where they worked, their chosen transportation method and gardening.

What prompted the initiative?

 In the UK 40,000 deaths a year are attributed to air pollution, and Southampton is in the UK’s top five most polluted cities.

What changes were implemented?

The project began with a call for volunteers to help reduce local air pollution.

Six teams (156 staff) volunteered. Each team were given evidence based knowledge about the impacts of air pollution and potential solutions to reduce it, but they could choose their own solutions.

The initiatives chosen varied widely, including home working, online meetings, walking to work, use of public transport, car sharing, planting 400 bulbs and four trees, and choosing to stop eating meat. 

Our mental health and learning disabilities teams moved away from air polluting diesel vehicles, and were provided with electric and hybrid vehicles to trial.

As a consequence, the Trust went on to cancel their orders for three diesel pool vehicles and replaced them with three hybrid pool vehicles instead.  

What benefits were achieved?

The volunteers saved £17,348 from their teams’ business travel expenses over the duration of the project.

Despite the project only running five months, the actions of the volunteers and their influence on other teams not directly participating in the project contributed to the Trust decreasing business travel spending by 4% or £182,966 compared to the previous year.

This project directly contributed to a reduction of 16.5 tonnes of carbon dioxide equivalent in our business travel, and 5.7 tonnes in our staff commuter travel, between 1 November 2018 and 31 March 2019.

Name of project

Transforming Mental Health Care

Where it took place

Hywel Dda University Health Board

Project description

A multi-sector Mental Health Programme Group (MHPG) was formed in 2015 to consider the challenges and opportunities in meeting the mental health needs of the local population.

The group aimed to develop a co-produced consensus model to meet these needs and is a project that is still ongoing.

The consensus model is based on the principles of early intervention, easy access and timely treatment, as well as information and support on a 24/7 basis.

What prompted the initiative?

 The existing service did not match the contemporary patient-led, prevention focussed, recovery-oriented approach in the field of psychiatry.

This project aimed to modernise the model of care to deliver services in a timely and effective manner.

What changes were implemented?

Several changes have been made to achieve these objectives.

There is now co-location of all of our Crisis Resolution Home Treatment Teams (CRHTs) and Community Mental Health Teams (CMHTs) to deliver intensive home treatment or a community assessment.

In addition, a psychiatric liaison services has been created which runs across all ages. A regional single-point of access is in place 5 nights a week and this was done alongside the Welsh government, with plans to extend this to 24/7.

The board supported third sector organisations, starting an out of hours crisis care centre running 6pm – 2am 7 days a week which targets service users’ needs and preferences. In addition, a twice daily, seven days a week Adult Mental Health MS Teams meeting has been established to manage potential admissions as well as leave or discharges from our wards.

What benefits were achieved?

The implementation of a psychiatric liaison team and single point of access has increased our early engagement rates, timely intervention and effective support for those in distress, the key to the prevention or escalation of mental ill-health.

Having twice daily meetings regarding admissions have resulted in reduced length of stays in our in-patient wards and an improved our position with regard to bed occupancy which is lower than the benchmark from the Royal College of Psychiatrists for bed occupancy of 85%.

Name of project

Technology Assisted Psychiatry (TAP) - introducing telepsychiatry into an Emergency Department psychiatric service.

Where it took place

Oxford Health NHS Foundation Trust

Project description

The Emergency Department Psychiatric Service (EDPS) provides psychiatric assessments to patients referred at a distant ED and wanted to trial telepsychiatry to reduce patient waiting times, and travel times and costs for staff.

Follow-up appointments were offered to patients in the brief intervention clinic, at a time convenient to them, using their own device. 

What prompted the initiative?

 The EDPS, based in Oxford, also covers a regional ED 27 miles away. There are delays in assessing patients at the distant ED due to travel time, and the team struggles to offer convenient times for follow-up appointments.

Assessments and follow-up appointments by telepsychiatry were introduced to reduce patient waiting times, staff time and travel costs and to increase access to follow-up clinics.

What changes were implemented?

We applied for, and were awarded, an 'Innovating for Improvement' grant from the Health Foundation, an independent health charity.

This allowed the team to employ a clinical project assistant and project manager.

We began sending weekly newsletters to the team once the familiarisation period started, with regular feedback from team and ED staff encouraged.

The team aimed to use low-tech solutions which other teams would be able to replicate easily. All clinicians in the Trust had been provided with iPads, and the team based the project on using these.

A relatively inexpensive ligature-free mount was sourced to be installed in the assessment room in the remote ED, and a cheap ipad holder (‘stick’) was found to be ideal for the clinician at the team base at the main hospital.

EDPS was fortunate in recruiting a patient expert by experience, who provided invaluable insights.

What benefits were achieved?

The project aimed to improve prevention by reducing waiting time in the Emergency Department, so that more patients are assessed, and increasing access to our self-harm follow-up clinic.

During the three month period,

  • 44 assessments were undertaken, saving 88 hours of clinician time and £975.92 in travel expenses.
  • 90% of new assessments and 100% of follow-up patients in the project data collection period rated their overall experience as ‘excellent’ or ‘good’.
  • 92% of clinicians said they were willing to use this technology again.

We continue to see around 50% of referrals from the remote ED using the videolink each month.

Towards the end of the project, a larger ipad was installed in the assessment room, and the original put into one of the inpatient wards which serves two rural community teams. 

EDPS encourage teams to use the video-link to keep in touch with inpatients and attend ward round remotely.


Name of project

Sustainable School Liaison  

Where it took place

Sussex Partnership NHS Foundation Trust

Project description

The Sustainable School Liaison project targets interventions to meet the mental health needs of children and young people.

Central to the project, a monthly consultation clinic held at the school and led by a consultant child psychiatrist and a senior member of the school serves as a focus point for multi-agency working including with Health, Education and Social Care.

What prompted the initiative?

 St Anthony’s has 203 pupils with a range of complex learning needs of whom approximately 40% lie on the autism spectrum · Many pupils are potentially vulnerable.

The project aimed to reconfigure services, to enable a move from symptom reduction and containment to prevention and social inclusion.

What changes were implemented?

Central to the project, a monthly consultation clinic was held at St Anthony’s and led by a consultant child psychiatrist and a senior member of St Anthony’s, which:

  • • Serves as a focus point for multi-agency working including with Health, Education and Social Care
  • • Is an opportunity for school staff to access supervision
  • • Allows the consultant psychiatrist and staff member to
    • meet with a child alone or with their parent or carer
    • meet with parents and carers alone
    • consult with school staff 
    • meet the child in whichever environment will most enhance engagement

What benefits were achieved?

The project involved the consultant psychiatrist travelling by bike. The school provided showers and secure bike storage facilities.

Pupils are seen at the school, negating the need for specialist transport to the local CAMHS clinic. 

Sticking to medication is discussed in each review to make sure no medications are wasted. Over-medication is avoided by adopting a recovery approach, and staff “prescribe” a range of community interventions instead, including equine therapy.

All appointments are made by phone or email, so no letters are printed. 

Staff at St Anthony’s make direct referrals to the project, and this reduces  the time from referral to treatment (previously up to 18 weeks; thanks to the project it is four to six weeks) or consultation, and stops the need for pupils to be reviewed by several different people before acceptance.

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