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Delivering a sustainable health and care system - specification document


Published: 17 January 2022

Version: 1.0

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The NIHR have issued a cross-programme call for research into the evaluation of interventions or services to support the delivery of a more sustainable UK health and care system, including mitigating the effects of climate change on health and care delivery. For the purposes of this call, the term ‘sustainability’ is defined as climate sustainability as opposed to financial, political, cultural or environmental sustainability

This call is a key component of the NIHR response in recognition of the need for further research based evidence related to the provision of more sustainable health, public health and social care services and processes and to support the UK’s ambition to deliver a ‘net zero’ NHS and meet the goals of the COP26 summit through:

  • Supporting capacity building across a wide range of disciplines and,
  • Increasing the volume of high-quality research on the effectiveness, delivery and organisation of health and care interventions and services to reach net zero carbon.

The expectation is that research funded through this call leads to the development of practical, real-world solutions with demonstrable impact in the short, medium and longer term. The NIHR is also particularly interested in the differential impact on inequalities that result from decreasing carbon emissions specifically ensuring that reductions in carbon emissions reduce, and do not increase, health inequalities.

Scope of the call

The following NIHR managed research programmes will be participating:

Research proposals must be within the remit of one or more of the participating NIHR programmes and given the remit of the NIHR to improves people's health and wellbeing, the primary outcome measure must be health related. Applicants should carefully consider the remit described for each programme. We are particularly interested in applications that:

  • support action to meet the COP26 goals
  • evaluate the effectiveness of existing or new interventions delivered across health, public health, and social care settings.
  • consider a range of health-related outcomes in addition to achieving carbon reduction
  • address whole system redesign
  • identify the key organisational, technical, legal and resource barriers which need to be overcome to foster positive change and what is required to overcome such barriers
  • support mitigation of the impact of climate change on health, health and care services and on health inequalities

Applications should be co-produced, demonstrating an equal partnership with service commissioners, providers, and service users in order to provide evidence and actionable findings of immediate utility to decision-makers and service users. Applicants may wish to consult the NIHR guidance on co-producing research. In addition:

  • The EME Programme is interested in evaluating novel and repurposed interventions which may be equally or more efficacious than current carbon-intensive technologies, such as (but not limited to) anaesthetic gases, inhalers and single-use technologies. The research should seek to establish the efficacy of the technology and should not be incremental. Also of interest are efficacy-driven approaches for the de-escalation of treatment, where carbon reduction may be realised through reduced waste, particularly in polypharmacy.
    EME also welcomes applications to undertake hypothesis-testing research to better understand the mechanisms underpinning the health-related outcomes of interventions in this space. Mechanistic applications should refer to the EME Funding Opportunities page.

  • The HSDR Programme is interested in commissioning evaluation of existing and/or new initiatives to reduce carbon emissions in health and social care services, including their implementation, whilst ensuring health and social care system resilience to climate change. Studies are needed to evaluate optimal models of carbon reduction practices in primary care, community, hospitals, mental health and social care settings and re-design clinical pathways to improve sustainability and shift care upstream where appropriate. Research is needed to test and evaluate models of engaging patients, service users and health and social care staff to shift to more sustainable practices, drawing on theory and research on leadership, engagement, and organisational behaviour and culture. New studies should ensure that that they also explore the impact on health inequalities of activities intended to help NHS and social care organisations reach net zero targets. The evaluation of initiatives or service re-design should not be focused on single local sites but should be more generalisable and therefore multi-site with a view to learning at a national level.

  • The HTA Programme is interested in comparative effectiveness and cost-effectiveness studies with the potential to inform more sustainable healthcare. The primary outcome of studies should be health related, however this may include non-inferiority designs, where differential carbon emissions between technologies may inform guidance.
    Potential areas of interest include but are not limited to: addressing emissions associated with inhalers and anaesthetic gases; effective alternatives to single-use technologies; the effectiveness of interventions which may be delivered or enhanced virtually, thereby reducing travel requirements.

  • The i4i programme is interested in proposals that seek to develop and evaluate innovative technologies and solutions in the MedTech and digital health fields, including IVD, that would contribute to reducing and/or eliminating carbon emissions, and that address the objectives set in the Delivering a ‘Net Zero’ NHS report. These solutions should already have considered the carbon impact on the chosen pathway and have demonstrated a robust proof of concept. The proposed research should clearly address specific carbon-intensive health and social care pathways, considering the lifecycle assessment of the proposed innovation and possible effects on other parts of the health and social care system, upstream and downstream. The i4i programme also welcomes innovative approaches towards the reduction of waste and recycling methods. Proposals should clearly outline patients’ benefits associated with the development, evaluation, and implementation of the sustainable solution. Applications that seek funding for translational development of innovative technologies addressing the Net Zero challenges, should be submitted to the i4i programme.

  • The PGfAR scheme is interested in programmes of research which involve a number of inter-related and linked components, using a range of methodological approaches, to answer important questions relevant to delivering a sustainable health and care system.
    Applications employing novel methodological approaches to demonstrate benefits at an individual or population level are encouraged. Examples include development and testing of interventions (including links with industry); using observational data to demonstrate benefit; public health interventions; social care perspectives, use of existing data from previous research, or routinely collected health care data. Applications which clearly demonstrate multidisciplinary approaches and are conducted in geographical locations of high health care need will be welcomed. Research may be carried out in community, primary or secondary care settings.

  • The PDG scheme is available for researchers to undertake preparatory work to develop a future programme of research. Broad ranging development work is permitted, with some high-level description about the future programme of research. Applicants should indicate how the PDG, and future programme will support the delivery of a more sustainable health and care system.

  • The PHR Programme is interested in research that functions at a population level and that takes account of the populations most exposed to the impacts of climate change. The PHR Programme recognises that the climate change agenda impacts different localities in different ways and interventions aimed at climate change mitigation can have positive and negative impacts on different populations. Applicants need to justify their choice of locality and population and how their research might, or might not, be generalizable to the whole of the UK.

  • The RfPB Programme is interested in evaluating the effectiveness of existing or new interventions compared to carbon-intensive technologies currently delivered across health, public health and social care settings. We particularly encourage ambitious and novel research proposals addressing new concepts and techniques to generate health co-benefits (eg. cleaner air, increased physical activity, and more nutritious diets), reduce environmental impacts, maintain or improve quality of care, and lead to an effective reduction of the NHS carbon footprint. The call offers researchers considerable flexibility to focus on any subject area, topics and research methodologies that are concerned with the day-to-day practice of health service and social care staff and aim at increasing the effectiveness of NHS services delivery to reach net zero carbon.

The funding arrangements for the NIHR-managed programmes contributing to this call are described on their individual web pages.

General guidance

  • Applicants should justify the importance of their proposed research and its potential impact on patient care.
  • Applicants should clearly state how their proposed research addresses an explicit evidence gap and how the research adds value to the existing NIHR research portfolio
  • Patient and public involvement should be included within the application and throughout the study design.
  • Applicants should consider contacting the NIHR Research Support Service and the NIHR Clinical Research Network or equivalent for early support

The NIHR is committed to actively and openly supporting and promoting equality, diversity and inclusion (EDI). All NIHR applications need to demonstrate they have met the requirements of the Equality Act (2010) by embedding EDI throughout the research proposal, ensuring there is no discrimination across the following domains; age; disability; race, including colour, nationality, ethnic or national origin; religion or belief; sex; sexual orientation; gender reassignment; being married or in a civil partnership; being pregnant or on maternity leave.

For further information on the participating programmes including open and close dates please see the call information page. Please note that submission dates vary and completed forms must be submitted by the date specified.