HSE Climate and Sustainability Programme – An introduction to the HSE Greener Models of Healthcare Framework

Decarbonising Care Pathways

Ireland's public health service, the HSE, is the country's largest single organisation and a material contributor to national greenhouse-gas emissions at a moment when the Climate Action and Low Carbon Development (Amendment) Act 2021 demands a 51% cut by 2030. Launched in June 2023, the HSE Climate Action Strategy 2023-2050 sets a net-zero target for 2050 across six pillars, one of which—healthcare provision—had until recently lacked a detailed operational plan.

The Greener Models of Healthcare Framework, finalised in 2025 with contributions from clinicians, pharmacists and researchers including at RCSI, fills that gap. It outlines seven high-level themes for redesigning care pathways around prevention, integration, and lower-impact interventions such as switching to dry-powder inhalers or mitigating nitrous-oxide use in anaesthesia.

Against a revised 2019 baseline of 605 ktCO₂e for modelled operations (full inventory 882 ktCO₂e), the 2025 Operation Zero decarbonisation roadmap shows business-as-usual growth would push emissions to 1,148 kt by 2050; applying the full suite of measures, including greener models, brings the figure down to 280 kt—a 76% cut from the projected baseline and 54% from 2019 levels. Greener models alone account for 181 ktCO₂e in projected savings, second only to sustainable procurement.

Real-world effects reach patients through fewer avoidable admissions and reduced exposure to pollution-aggravated conditions, hospitals through eased capacity pressure, and the 130,000 HSE staff who must now embed new protocols in daily practice. The framework also aligns with Sláintecare reforms that move more care into the community, where travel and resource intensity are lower.

Yet concrete risks of inaction are stark: missing sectoral carbon budgets could trigger EU compliance costs and reputational damage, while climate-driven health burdens—heat stress, respiratory disease, flooding-related injuries—would further strain a system already operating at capacity. Energy-price volatility and supply-chain inflation have already hit budgets hard; unchecked emissions growth would compound those pressures.

Non-obvious angles include the framework's challenge to entrenched incentives in primary care, where contractors are paid per item or visit, potentially clashing with prevention-focused models, and the fact that changing clinical pathways can deliver health co-benefits—better asthma control from low-carbon inhalers, for instance—that pure efficiency drives often miss.