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22/102 HSDR Supporting the delivery of net zero health and social care system - commissioning brief


Published: 03 August 2022

Version: 1.0 - November 2021

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Closing Date: 1pm on 16 November 2022


The Health and Social Care Delivery Research (HSDR) Programme is interested in receiving applications for high quality and timely evaluative research of existing and/or new initiatives to reduce carbon emissions in care pathways and health and social care services, including their implementation or service re-design models, whilst ensuring health and social care system resilience to climate change. The evaluation of initiatives or service re-design should not be focused on single local site but should be more generalisable and therefore multi-site with a view to learning at a national level. 


The UK is the 17th largest global emitter of greenhouse gases per capita and health services contribute around 4-5% of total UK carbon emissions. The Climate Change Act (2008), which committed the UK to reduce its carbon emissions by 80% by 2050, is superseded by the government’s ambition to pledge to net zero by 2050. Building on this, the report from NHS England and NHS Improvement, “Delivering a ‘Net Zero’ National Health Service” sets out a comprehensive plan for achieving a net zero NHS by 2045 (NHSEI, 2020)NHS England’s Long-Term Plan for the NHS also sets targets to deliver significant and accelerated reductions in total emissions.

Climate change has altered weather patterns and increased sea levels globally and will continue to do so without immediate action. There are increasing numbers of illnesses, and deaths from extreme events (e.g., heat waves, storms, and floods) and these risks will exhaust the healthcare system capacity in the future. In addition, vulnerable people are likely to be at greater risk of effects of climate change, from disruption to services to impact of extreme weather events. The 2021 Climate Change Committee Progress report has made recommendations for the Department of Health and Social Care to assess health and social care sector vulnerability to existing and future climate risks, and to support the NHS in delivering its Net Zero plan whilst playing an active role in climate policy development. In a recent BMJ editorial, more than 200 health journals have urged governments to take emergency action to tackle the “catastrophic harm to health” from climate change.

The healthcare sector is a large-scale consumer of energy, pharmaceuticals, and chemicals and therefore, considering how products are chosen, purchased and utilised can have a huge impact on patient wellbeing, healthcare costs and reducing environmental harms.  While the setting where care is delivered plays an important factor on the environmental impacts, sustainability raises more fundamental questions about how and what kind of care is delivered. There is a need to understand which care pathways have the greatest impact on the environment and what clinically appropriate alternatives might be available. Innovative examples of decarbonising procurement and medicine such as reducing anaesthetic practice at the University Hospitals Bristol Trust may help to understand the impact including contextual factors, barriers, and facilitators to implementation of these practices.

The COVID-19 pandemic crisis has underlined the need for being prepared in the management and prevention of the serious consequences of climate change around the world. The post-pandemic recovery is an opportunity to redirect environmentally damaging products and services to more productive and sustainable options . Although measures to control the COVID-19 pandemic (e.g. lockdowns) are associated with some positive environmental effects, including reduction in global carbon dioxide emissions, there have also been negative impacts such as waste management of personal protective equipment (PPE) including single use surgical masks, gloves, and gowns and people using cars more to avoid public transport.

Areas of interest

Proposals submitted to the HSDR Programme are likely to be mixed-method studies led by a team with a track record in multi-site and multi-disciplinary evaluations of new interventions, care pathways or health and social care services and their implementation. Studies are encouraged in a range of sectors, from primary care, social care, community care and mental health to acute settings.  The impact of these interventions on health inequalities should also be assessed. Successful applicants are likely work across different disciplines and use networks, and other means of sharing best practice in sustainable health and social care services. The HSDR Programme encourages new multi-disciplinary teams that are innovative in their research plan and team configuration, perhaps forming partnerships with colleagues across different departments such as architectural, geographical and earth sciences, either in their own organisation or externally. No specific study design or topic relating to sustainable healthcare is prescribed, but components of the research are likely to include the following:

  • Implementation of existing models: Optimal models of carbon reduction practices in primary care, hospitals, mental health and other health and social care settings with a focus on areas such as:
    • Approaches to efficient use of drugs and pharmaceuticals through adequate stocking and appropriate prescribing practices.
    • Systems or methods of balancing infection control and environmental impact of single use versus limited multi-use devices and equipments.
    • Understanding which care pathways have the greatest impact on the environment and what clinically appropriate alternatives might be available.
    • Improved productivity or reduced inefficiencies in a clinical pathway such as reducing length of stay or number of follow-up appointments.
  • Innovative models of care: Pioneering models for achieving carbon reductions through new and re-designed clinical pathways and optimised services.
    • Service re-design to shift care upstream and place greater emphasis on primary care, prevention, and self-management as broader trends which can have an impact in terms of overall demand on services and their carbon emitting activities.
    • Approaches to reduce travel for both patient and staff through innovations such as telecare, remote consultations and services, and care closer to home.
    • Uptake of new technologies (including recent shifts to greater use of remote consultations, digitally supported self-management, and remote monitoring) across health and social care sector for optimal waste management and carbon reduction.
    • Models of care to reduce health inequalities and carbon consumption simultaneously.
    • Models of self-care to help carbon reduction through digitisation of primary and secondary care services.
  • Leadership, culture, and behaviour change: Models of engaging and empowering staff and patients.
    • Embedding environmental sustainability across different workforce groups and at all levels of leadership and stages of career, including curriculum and early training as well as continuing professional development.
    • Approaches to enhance cultural change in attitudes of patients and health and social care workforce towards wastefulness and inefficiency.
    • Models of engaging, empowering, and supporting staff to make sustainable choices for commuting, improving resource efficiency and reducing carbon emissions and waste at work.
    • Organisation of workforce and measures to ensure corporate performance in reducing carbon, such as Board-level reporting and sustainability leads in health and care organisations.
    • Educating and engaging patients in making sustainable choices for their care.

The call is looking for well-designed research studies with national reach, with strong theoretical grounding, to deliver robust national learning, strengthen the evidence base on reducing carbon footprints in health and social care settings and provide actionable findings. Use of appropriate controls or comparisons should be considered to increase robustness of evaluations. The focus should be on understanding the implementation and measuring the impact of models/care pathways, to create sustainable services and systems rather than research which is only descriptive.