Cross-programme

Decarbonising the health and social care system

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Overview

  • Opportunity status:
    Open
  • Type:
    Programme
  • Opening date:
  • Closing date:
  • Reference ID:
    2024/217

Ready to apply?

Apply for this funding opportunity through our online application form

We are looking to fund research into decarbonising the health and social care system. As part of our climate  health and sustainability commitments to help reduce carbon emissions and achieve net zero, this cross-programme funding opportunity will run annually for the next 5 years. There will be £25 million total funding available across the 5 years, with a new application process opening each year.

This is a two-stage, commissioned funding opportunity. To apply for the first stage you should submit an Outline Application. If invited to the second stage, you will then need to complete a Full Application. We expect to commission projects which range in size and scope, with a guideline minimum of £200,000. As part of our drive to develop capacity, this opportunity also encourages capacity building and training.

Your proposed research should aim to generate high-quality evidence, focused on decarbonisation of the health and social care system, that supports both innovations and/or existing: 

  • interventions
  • service models 
  • care pathways 

A number of our Domestic programmes are taking part in this funding opportunity. Projects can cross boundaries between the remit of different programmes. You do not need to make a separate application to an individual NIHR programme, or specify which of the programmes’ remit your project falls under. 

Webinar and workshops

We held an online workshop on 6 November 2024. You can watch the recording of the Decarbonising the health and social care system: funding opportunity pre-launch workshop on YouTube. We also ran a webinar and an in-person workshop.

We will be running Research Support Service (RSS) online support sessions on 12 December 2024 and 16 January 2025, from 1pm to 4pm. Complete our RSS Support Session Booking Form to book a 20-minute slot  with the sustainability specialists at RSS Lancaster. You will need to provide a summary of your research idea, along with the questions you would like the team to answer. Slots will be allocated on a first-come-first-served basis.

Timeline

27 November 2024

Outline Application opening date

12 December 2024, 1-4pm

Research Support Service (RSS) online support session 1 

16 January 2025, 1-4pm

Research Support Service (RSS) online support session 2

26 March 2025, 1pm

Outline Application closing date

June 2025

Full Application opening date

August 2025

Full Application closing date

November 2025

Full Application funding decision

Funding applications must be submitted via our Awards Management System. Click the link below to log in to the system and start your application.

Apply now

Research specification

We aim to generate evidence to support the decarbonisation of the health and social care system and build research capacity in this area. We are interested in high-quality research evidence that supports both innovative carbon reduction measures and/or existing interventions, service models, and care pathways focused on decarbonisation of the health and social care system. Research into the development, evaluation, and/or implementation of such interventions is all within the scope of this funding opportunity. Applicants will need to demonstrate “proof of concept” and a clear pathway of impact to be considered as innovations. We recently announced our commitment to building capacity and funding research into climate, health, and environmental sustainability. This funding opportunity is part of our commitment to help the health and social care system become more environmentally sustainable and achieve net zero.

We welcome applications for both new primary research studies and evidence synthesis. Research to establish the effectiveness and cost-effectiveness of new, promising, or existing solutions and to support the translation of effective research and innovations into policy and healthcare practice is in scope. In addition, evaluation of interventions and models of care that impact carbon emissions is also within the scope of this funding opportunity. Research examining and developing approaches to measure, report, and mitigate carbon emissions in the social care sector is within remit. This funding opportunity is for £5 million a year, over 5 years, therefore multi-year proposals are welcome. We anticipate funding a range of projects, from developmental awards to significant large-scale proposals.

Context

About 4-5% of the UK’s total carbon emissions come from the health services, and the NHS is responsible for 40% of the public sector’s emissions [NHS England 2021]. It is estimated that the greenhouse gas emissions from clinical activities in secondary mental health care account for about 1,510 kilotonnes (kt) of carbon dioxide equivalent (CO2 e), or 6% of emissions from the NHS as a whole [National Collaborating Centre for Mental Health 2023, Royal College of Psychiatrists]. Huge progress has already been made with reducing the carbon footprint of the NHS, with a reduction of 26% between 1990 and 2020 [Hopkinson 2022, Open Research Exeter]. However, it is important to maintain the momentum of these efforts and also extend them beyond the NHS. The social care sector has also made progress, but at a slower pace than the NHS. More than 50% of health and social care providers lack an adequate environmental strategy to measure their impact on the environment [Fergus 2022, Time to act healthcare report (.PDF)].

The Achieving Net Zero report has highlighted the critical role of local authorities in achieving net zero in the care sector. Given the complexity of health systems, decarbonisation initiatives need to adopt a whole systems approach in order to be truly effective. The supply chain, health and social care delivery, and workforce training are some of the key aspects to consider and tackle to reach net zero targets [Dzau 2021, The New England Journal of Medicine].

Public health initiatives that help lower the demand for health and social care services will play a key role in reducing carbon footprints. For example, supporting people to quit smoking results in lower carbon emissions than treating smoking-related illnesses. Similarly, supporting patients in better self-management of chronic diseases will reduce the need for more carbon-intensive forms of care.

All care settings are associated with a carbon footprint, for example:

  • energy consumption
  • waste generation
  • travel
  • greenhouse gas emissions

Actions targeted to enhance the environmental sustainability of health and social care delivery can result in cost savings, bringing improved productivity and efficiencies, as well as better patient outcomes [NHS England 2020].

Research into innovative solutions, evidence-based practices and interventions, treatments, and approaches focused on reducing carbon emissions and implementation at scale are key to enabling effective decarbonisation within health and social care systems.

Scope

Any research proposals meeting the scope of the brief and our remit of improving people’s health and wellbeing will be considered. Some specific themes have been identified, however, proposals are not limited to these themes. Additional evidence gaps that may be addressed through this funding opportunity are listed in the ‘Supporting information’ section below. Co-production of research proposals with charities, local authorities, third sector organisations, industry partners, and other relevant stakeholders is strongly encouraged. Working collaboratively with implementation specialists, policymakers, and relevant stakeholders such as the National Institute of Care Excellence for the successful implementation of the research findings is also supported.

The focus of the proposed research can range from development, feasibility, and acceptability to evaluating effectiveness, cost-effectiveness, and implementation of interventions. Research to understand the impact of low-carbon interventions and models of care on service users, carers, and the health and social care workforce, particularly from different ethnic backgrounds, may also be considered. The proposed research should not be purely descriptive. It should consider measuring the impact of low-carbon interventions on prevention of disease, models/care pathways, health and social care technologies, workforce and/or patient, service user, and public empowerment to create sustainable services and systems in practice. Research looking at adding carbon reduction outcomes to existing trials or studies within trials (SWATs) is in scope. Research focused on the social care sector can look at identifying and understanding ways to report and measure carbon emissions and their assessments as well as mitigate carbon emissions. Supporting and empowering the social care workforce and public through carbon literacy programmes and promotion of low-carbon models of care is in scope.

You may wish to consider the following themes, however, proposals are not limited to these areas:

  • developing sustainable health and social care pathways
    • evaluation of evidence-based innovations in the provision of health and social care systems that reduce energy consumption, waste, and greenhouse gas emissions
    • evaluation of sustainable alternatives to single-use products in health and social care, including their effectiveness and cost-effectiveness (for example, inhalers used in asthma management, single-use syringes used in care homes, diagnostic or surgical equipment)
    • research into the development of approaches to measure and report carbon emissions in the social care sector
    • development of protocols for minimising waste and promoting recycling in social care settings
    • research exploring the workforce culture shift and behaviour changes, knowledge, and skills needed to deliver net zero clinical care pathways
  • reducing carbon emissions in healthcare through preventative and personalised care
    • development and evaluation of lower-carbon models of care; assessment of the environmental impact of disease prevention and health screening in primary and community settings
    • evaluation of low-carbon lifestyle interventions (for example, diet, exercise), including understanding the mechanism of lifestyle change and its impact on carbon footprints
    • strategies for training, supporting, and empowering the health and social care workforce to deliver low-carbon and preventative care programmes with a focus on deliverable impact
  • innovations in diagnostic, imaging, and surgical services
    • development and evaluation of innovative approaches towards energy-efficient diagnostics such as imaging technologies and diagnostic closer to home and community, as well as research optimising the use and scheduling of diagnostic equipment
    • evaluation of the emerging and innovative initiatives, including remanufacturing, refurbishment, and recycling strategies, to pursue a circular economy in healthcare
    • evaluation of the environmental impact of adopting low-carbon alternatives focused on improving circular economy and its implementation (for example, reusable surgical gowns, sterilisation, decontamination) for common diagnostic tests and procedures
    • research on optimal strategies for reducing waste and measuring environmental impact and lifecycle cost benefits of disposable versus reusable surgical instruments, including barriers and facilitators to implementation of such strategies
    • research into the effectiveness of interventions that reduce carbon emissions in the transition of care from secondary to primary care, including measuring the digital carbon footprint of various technologies used
      • in addition, research on understanding the carbon footprint of digital and artificial intelligence solutions and measuring their co-benefits
  • empowering patients to manage their own health
    • evaluation of low-carbon interventions that focus on human behaviour change and how they approach energy conservation while managing chronic diseases (for example, diabetes, hypertension)
    • research to support patients in understanding the environmental impact of long-term medication use and promoting potential low-carbon alternatives to minimise the environmental impact of medicines
    • strategies for communicating and incorporating patient and public views and preferences into developing sustainable care, including patient education and self-management programmes
  • self-management, prevention, and earlier detection of mental health conditions
    • evaluation of the impact of low-carbon mental health care pathways on prevention and health promotion practices in mental health
    • evaluation into the effectiveness of the use of nature-based, greener, or remote interventions and their impact on mental health care pathways
    • research into the long-term impacts and sustainability of low-carbon mental health interventions and services

Research capacity development

You may include up to 10–20% of the total funding for research capacity development that supports diverse career paths (including internships, pre-doctoral/masters, doctoral/PhD, and post-doctoral), promotes greater equity of opportunities for under-represented groups, disciplines, and professions in research, and offers funded career development posts in line with what is needed in the programme and where there is a need for building research capacity and supporting research careers. Training and support should be in line with the principles and best practices set out within the Researcher Development Concordat.

If your academic career development is being supported through our Decarbonisation funding opportunity and you are undertaking a formal training/career development award, you will become an NIHR Academy member. This means you will benefit from the wider NIHR Academy programme of support, events, and activities.

Additional information

You are strongly advised to consider assessing impact, which is not limited to patient outcomes and also includes the environmental, social and economic impact of your proposal.

Carbon and environmental impact may be measured utilising existing tools, data repositories, and methodologies (for example Healthcare LCA ). A full carbon life cycle assessment is not a requirement.

This funding opportunity represents one of our ongoing areas of interest. Following this opportunity, we will still be interested in receiving applications in this area to our programmes’ researcher-led workstreams.

Supporting information

In addition to the themes identified in this commissioned funding opportunity, we would also like to highlight several evidence gaps that are within scope: 

You should make sure that any relevant research (NIHR or non-NIHR) is cited in your proposal and you should justify how your application complements the existing evidence. See the examples below of recently funded NIHR research on sustainability. This is not a comprehensive list and you should endeavour to include relevant research in your application. 

  • HSDR NIHR152311 - SUMU-Endo: Single-use versus Multiple-use Endoscopes in gastroenterology: multi methods analysis to balancing infection control and environmental impact. Active. Due to complete June 2025
  • HSDR NIHR153231 - Implementation of decarbonisation actions in General Practice to help achieve a net zero NHS. A mixed methods study of institutional, organisational, professional, and patient factors (GPNET-0 study). Active. Due to complete February 2026 
  • HSDR NIHR135113 - Investigating innovations in outpatient services. Completed 2022 
  • HSDR NIHR155944 - Initial study to coMpare the carbon footPRINT, patient experience and resources of standard and hypofractionated radiotherapy (IMPRINT). Active. Due to complete October 2025
  • HSDR NIHR157800 - FAST-Forward Boost: A randomised clinical trial testing a 1-week course of curative simultaneous integrated boost radiotherapy against a standard 3-week schedule in patients with early breast cancer. Due to complete July 2033
  • HTA  NIHR163807 - Development and prototype testing of a method to quantify the carbon footprint of current clinical trials to inform future lower carbon trial design. Active. Due to complete June 2025
  • PHR NIHR150330 - Developing a research agenda for health benefits of local climate action. Completed 2022
  • PHR NIHR150730 - Exploring the evidence gaps related to the priorities of Local Authorities for mitigating the health and health inequality impacts of climate change. Completed 2022
  • PHR  NIHR150799 - Development Award Local authority-level research priorities on climate change. Completed 2022
  • PHR NIHR152858 - Evaluation of the Binley cycleway: an economic analysis and model development to support investment in local government active travel policy. Active. Due to complete January 2026
  • PHR NIHR153617 - In2Air: the impact of 'net-zero' household energy intervention on indoor air quality, occupant self-reported general health and wellbeing, and household energy use. Completed 2023
  • PHR NIHR129406 - The air quality, health and economic costs and benefits of a zero carbon UK. Completed 2023
  • PHR NIHR129440 - Assessing Mitigation Pathways to Realise Public Health Benefits of Air Pollutant Emission Reductions from Agriculture (AMPHoRA). Completed 2023  
  • RfPB NIHR204349 - Fan Feasibility Randomised Controlled Trial (RCT) for people living with COPD and high SABA intake (Fan FIRST). Active. Due to complete April 2025  
  • PGfAR NIHR204403 - Developing environmentally sustainable operating theatres. Active. Due to complete October 2027
  • NIHR Local Authority Fellowship NIHR302206 - How can our communities in Bolton come together to make sustained change and accelerate our progress towards net-zero carbon emissions? Active. Due to complete May 2025
  • NIHR Fellowships RP 2014-04-032 - Health and economic benefits of active travel in England. Completed 2019 

Application guidance 

Please read our Domestic Outline Application guidance to help you complete all aspects of your application. You must read this alongside the information below, which details specific application requirements for this funding opportunity. Please disregard the programmes listed in the Domestic Application guidance. This is because a number of our Domestic programmes are taking part in this funding opportunity. Projects can cross boundaries between the remit of different programmes. You do not need to make a separate application to an individual NIHR programme, or specify which of the programmes’ remit your project falls under.

Research Plan

You will need to upload your Research Plan within the ‘Application details’ section of the application form. Your Research Plan should be a maximum of 4 A4 pages in length, including diagrams. Please include the following information when writing your Research Plan and see our Domestic Outline Application guidance linked above.

Please provide the precise aims and research questions your project will address, justifying these with reference to relevant literature.

Provide an expert summary of your project plan plus any additional points required to support statements made in the previous sections of your application. Include any key references required to justify them (for example if using particular outcome measures or methods of analysis).

Research design

Please clearly summarise the type of study design you will be using. For example, Primary research: controlled trial; Evidence synthesis: systematic review. Include methods, proposed sample and analysis methods, and explain why you have chosen the proposed methodology. 

You should also upload a logic model (single-side of A4), as a separate PDF file when submitting your application. This should illustrate the study design, the flow of participants and the elements of your study that relate to decarbonisation. If  your project consists of more than one work package, consider a diagram that conveys the sequence and timing of research packages as well as how the work packages are linked. 

For qualitative work it may be appropriate to set out your theoretical framework. 

For primary research, please clearly summarise your study design including all of its components (for example primary and secondary outcomes, process and economic evaluations). Also include relevant time points for baseline and follow-up data collection for each component. You should make reference to established research techniques, providing details of how exposure to the intervention will be determined or defined. You should fully explain and justify any adaptations of these for the purposes of the research proposed. Where an RCT is being proposed, please describe and justify the chosen method of randomisation.

For Evidence synthesis, if you are proposing a systematic review and/or an evidence synthesis, please provide details about the size of the available literature base, along with details of the search and review strategy. Where  proposing to develop an intervention, you will need to demonstrate “proof of concept” and a clear pathway of impact.

For clinical trials, please note that we will double check all proposals recommended for funding which involve a clinical trial. We will check for potential overlaps using WHO trials before we communicate any funding decision. Consequently, a funding recommendation may not be taken forward if a major overlap is identified at this stage. It is therefore important that you highlight any potential overlaps before your application is considered by the Funding Committee. You should then explain how you expect your proposed research will add to the body of knowledge, referring to current policy and practice.

If your application proposes to carry out feasibility and/or pilot studies, you should include clear criteria to judge whether progression to the definitive study is justified. If you are proposing a definitive trial, you should include details of any prior feasibility and/or pilot work as an upload. You should also detail how the progression criteria of the feasibility and/or pilot study have been met. There are no set progression criteria to use but you should aim to address whether the uncertainties that were set out to be resolved in the preliminary studies have been determined. Examples of progression criteria could include (but are not limited to):

  • can/did you recruit people/centres within a reasonable timespan?
  • is/was the intervention sufficiently acceptable and feasible to implement?
  • was the intervention delivered with reasonable fidelity?
  • do you have commitment to fund the intervention for the duration of the study?
  • can the outcome measures be measured across your target population?
  • is the underlying question still the same/has the context changed?
  • do you have reasonable estimates of effect size and variability to inform a sample size calculation?
  • have you established whether there is contamination between the arms of a cluster study and any strategies to mitigate this?
  • does the initial evaluation suggest that the intervention could be effective?
  • has the study led to refinement of the logic model?

Please note that the criteria listed above should be used as a guide only and does not represent a comprehensive list of all the progression criteria that should be included within an application.

Where relevant, please describe:

  1. Planned intervention: you should include details of the planned intervention(s) and components, and their frequency and intensity, theoretical basis, specific techniques used, modes of delivery, and who will deliver the intervention. You may like to refer to the TiDIER guidance on reporting interventions (Template for Intervention Description and Replication (TIDieR). Providing a clear description of what’s being evaluated or studied is key to justifying the need, value and importance of a study. It is also essential to explain to our Funding Committee how the study design is fit for purpose. We have a broad view on what constitutes an ‘intervention’ or policy under evaluation
  2. Control/comparator group: please state what appropriate comparator(s) will be used in an evaluation and how it will be selected
  3. Study population: which population(s) will be the target for the intervention and the subject of the research? How will the population(s) be recruited and retained?
  4. Setting: where will the research be undertaken and the intervention delivered?
  5. Outcome measures: please state and justify the primary and secondary outcome measures
  6. Methods for data collection: for each outcome, process or economic study component proposed, please state the source of the data to be analysed. Where this is primary data collection, please state the quantitative and/or qualitative method used where appropriate. Where this is secondary data, please describe the characteristics of the dataset and the process by which access will be obtained
  7. Sample size: please describe and justify the proposed sample size for each element of the study. Justify the values used in the calculation by giving their source or some sensitivity around assumed values
  8. Data and analysis: please provide details of how each study data set will be analysed. Clearly state the purpose of any statistical analysis. You must state the proposed type and frequency of analyses including the selection of participants that will be included in the analyses. Describe any planned interim and sub-group analyses, sensitivity analysis and how missing data will be handled
  9. Health economic evaluation: understanding the value of health interventions – whether the outcomes justify their use of resources – is integral where resources relating to different economic sectors and budgets are potentially relevant. The main outcomes for economic evaluation are expected to include health (including health-related quality of life) and the impact on health inequalities as a minimum, with consideration of broader outcomes welcomed. We encourage different approaches to economic evaluation as long as they assess the value and distributive impact of interventions. If your application does not include an economic component, you should provide appropriate justification
  10. Stakeholder engagement: you are strongly encouraged to ensure that a wide range of stakeholders, including decision-makers, commissioners, and people with lived experience, are meaningfully involved in the design and planning of the research and throughout the work. You might do this through involving them as costed/rewarded members of the research team 
  11. Study management plans: please state how your study will be managed, and who will manage it. Refer to the roles of specific applicants as appropriate. There should be a named person with appropriate skills and experience who is responsible for leading the patient and public involvement (PPI) element within the project. Your proposal must also address our research inclusion requirements. Please see our Domestic Outline Application guidance for more detail on PPI and research inclusion. Where applicable, this section should also describe how any conflicts of interest will be managed, such as involvement of stakeholders with a financial or non-financial interest in the intervention in the study team
  12. Research governance and ethical approval: please indicate what research governance issues will need to be addressed in your research and state how you will seek and obtain ethical approval. You must either comply with the research ethics framework formulated by the Economic and Social Research Council (ESRC) or get approval via the National Research Ethics Service (NRES) 

Embedded Methodological Studies within a project/trial or review 

This funding opportunity supports embedded studies that evaluate approaches to support projects, trials, or evidence review delivery success within the main study (SWATs/SWARs) within applications. 

Many studies take longer than planned, either struggling to recruit or retain participants, or going over budget. We are interested in working with researchers to evaluate interventions to make studies more efficient. You may apply for up to £30,000 funding to evaluate alternative ways of managing studies as part of your main study. Any SWATs/SWARs proposed should represent a minor element of a larger study and must not undermine delivery of the main study. See the Northern Ireland Hub for Trials Methodology Research website for some examples. You are also encouraged to review the work of Trial Forge and consider our Trial Forge additional guidance for support with how to write about SWATs/SWARs within an Outline Application or Full Application research proposal. 

SWATs/SWARs may not all be powered to provide meaningful outcomes but will be useful for meta-analysis and you should consider using protocols published on the Northern Ireland MRC Trials Hub for Methodology Research SWAT registry. If you  wish to include a SWAT/SWAR in your study, you should indicate this in your first stage application. A detailed description of the SWAT/SWAR is not required at this stage.

Timeline and milestones

Please provide a clear indication of the study timeline and dates by which key milestones should be achieved.

Uploads

Please also upload the following files in the ‘Uploads’ section of the application form:

Flow Diagram (mandatory)

Upload a one-page flow diagram detailing study timelines and milestones.

Logic Model and Theory of Change (mandatory)

Upload a one-page logic model and theory of change to help explain the intervention being evaluated. Please detail which elements of the study specifically relate to decarbonisation or environmental impact.

References (mandatory)

Upload one single-side A4 page as a .PDF document, listing references used throughout your application. Please include the DOI of the main related publications. Please use the Harvard or Vancouver referencing style. 

Application process

Find out how to apply for this funding opportunity and what you need to do to get your application ready

How to apply

When you are ready to apply, you will need to log in to our application system to apply. This funding opportunity is on our new Awards Management System and you will need to create a new account to apply.

The closing date is 26 March at 1pm. Applications received after 1pm on the closing date will not be considered. 

Please read the following guidance before submitting an application:  

  • all the information highlighted in the ‘Application guidance’ tab of this funding opportunity

Download application form template

You can download a Word document template of the application form below. Please use this template as a guide only, to help you prepare your application. For example, to see how many characters are accepted in each section and to see how information in the form is laid out. Please do not try to use this as an application form; it cannot be submitted as an application. You must submit your application online via our Awards Management System.

Domestic Outline Application form template

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Research inclusion and reasonable adjustments

At NIHR we are committed to creating a diverse and inclusive culture. We encourage applications from people from all backgrounds and communities bringing diverse skills and experiences. If you need any reasonable adjustments throughout the application process, please contact the programme team via the information in the Contact Details tab.

Research Support Service

Got a research idea and not sure how to turn it into a funding application? The free NIHR Research Support Service (RSS) supports researchers in England to apply for funding. It can help you develop and deliver clinical and applied health, social care and public health research post award. 

If you would like specialist sustainability support with developing your proposal, contact nihr-rss@lancaster.ac.uk who will offer guidance on your study design and methods. 

Contact Details