A new organising framework for healthcare decarbonisation research

The NHS-SOS framework

Healthcare systems are a major source of global greenhouse gas emissions, accounting for almost five per cent of emissions. To put this in perspective, if the global healthcare sector were a country, it would be the fifth-largest polluter on Earth. The impact is so serious that the World Health Organization and its member states have called for action “at pace and scale,” which has led to the formation of the Alliance for Transformative Action on Climate and Health.

The NHS in England has set ambitious targets to reach “net zero” carbon emissions by 2040 for its direct footprint and by 2045 for its “extended footprint”, which includes its supply chain. However, research into how best to cut carbon emissions has been fragmented.

Why did we need an organising framework for healthcare decarbonisation research?

Decarbonising healthcare is a complex task involving a wide range of people and organisations, from government officials and healthcare professionals to patients and businesses.

In the past, decarbonisation activities, and the research which supports them, have usually been categorised by emission sources or by broad thematic areas. Without a more detailed organising framework, the research community risks:

• Failing to effectively translate scientific evidence into policy and practice.
• Working in silos and missing opportunities to collaborate with each other.
• Overlooking important gaps in knowledge.

Our aim was to develop an organising framework for healthcare decarbonisation research, focused on the NHS in England but also applicable to other healthcare systems, to support the coordination, funding, and application of research into policy and practice. We called this framework the NHS-SOS framework, with the acronym referring to the six top-level themes of the NHS-SOS framework.

How did we develop the NHS-SOS framework?

To develop the framework, we reviewed and derived research questions from a wide variety of sources including systematic reviews, stakeholder documents, research prioritisation exercises, and funding calls. We looked for common themes among the questions we found during the review and grouped them into categories.

We used the categories to build the framework, organising them into six main themes, each of which provides a different way to look at the problem and highlights specific areas where people can take action to cut carbon:

• Natural resource use and sources of carbon
• Healthcare settings and workflows
• Solutions
• Stakeholders
• Organisational levers for change
• Scientific measurement and theory.

What does the framework mean for research and practice?

The NHS-SOS framework is intended to provide structure to the emerging field of research into the decarbonisation of healthcare. It is a starting point for constructing a shared holistic understanding through a process of co-production and collaboration. The overall aim of the framework is to improve the prioritisation, design, conduct, relevance, and timely flow of research into healthcare practice and policy. While the framework was built for the UK, it is hoped it will be relevant for other countries.

In the future, we plan to develop it further in collaboration with research funders, policy-makers, healthcare professionals and patients, drawing on their expertise and experience. We envisage a wider range of sources being used to refine future iterations of the framework, for example institutional ‘green plans’ or industry technology competitions.

Key takeaways

1. Healthcare is a major climate contributor
   Healthcare systems generate almost 5 per cent of global greenhouse gas emissions making urgent decarbonisation essential.
2. The NHS in England has ambitious net zero targets – but research is fragmented leaving gaps and missed synergies
   The NHS in England aims to achieve net zero by 2040 (direct emissions) and 2045 (extended footprint including supply chains), yet research and action have been siloed and uncoordinated. A fragmented research landscape creates risks and inefficiencies that hinder the ability of the healthcare sector to respond to the climate crisis effectively.
3. A unified framework is needed to coordinate action
   Without an organising framework, research efforts risk duplication, missed knowledge gaps, and weak translation of research into policy and practice.
4. The NHS-SOS framework provides a structured, system-wide approach
   This first-of-its-kind prototype framework provides a structure, with six top level themes to classify healthcare decarbonisation research.
5. Designed for practical impact and global relevance
   The framework provides a foundation for a future co-produced shared understanding of this emerging field which will support more effective and timely research and evidence informed policy.

The framework provides a foundation for a future, shared understanding of this emerging field. This understanding will be co-produced, to support more effective, timely research and help lead to policy that is better informed by evidence.