OBJECTIVES: Involving and engaging the public is an essential step to build trust and confidence in HTA organizations. National Institute of Health and Care Excellence (NICE) runs a deliberative public engagement program, NICE Listens. It is used to gather informed public opinion on moral and social value issues. Climate change poses a major threat to our health as well as our planet. NICE Listens was used to explore public opinion on NICE’s role in making healthcare more environmentally sustainable.

METHODS: Twenty-three general public participants from across England took part in 3 iterative online workshops (each lasting 2 or 3 hours, held 3 weeks apart in 2022). They incorporated a range of stimuli including trade-off exercises, role-play, and video clips from interviews with sustainable healthcare experts.

RESULTS: There was strong public support for NICE taking action to make healthcare more environmentally sustainable. Support increased as participants learned that sustainable healthcare offers co-benefits, such as reduced burden on the NHS through better self-management of conditions. Participants did not want health outcomes to be compromised in pursuit of sustainability. We identified some circumstances where they found it acceptable to consider the environmental impact of interventions in decision-making: when effective treatments are already available for a condition; when the condition is not severe; when the alternative is equally cost-effective (i.e. “tie-break” function); and when the greener option is marginally higher in cost but as clinically effective as the alternative.

CONCLUSIONS: The findings demonstrate that sustainability is clearly considered a relevant element of value. They also offer insight into how the environmental impact of a health interventions should be considered in HTA and guideline development. Further research should focus on methods for consistent measurement of the environmental impacts of health interventions and the incorporation of those impacts into decision-making.