NHS Scotland - climate emergency and sustainability: annual report 2021 to 2022

7. Sustainable Procurement, Waste and Circular Economy and (SPWCE)

The carbon footprint of the £2.4 billion worth of products and services procured by NHS Scotland each year is significant and is thought to account for greater than 60% of the total NHS Scotland footprint. We therefore also aim to maximise our contribution to Scotland and our supply chain achieving net zero emissions by 2045. NHS Scotland is not alone in this endeavour. NHS England has committed to achieving a net zero supply chain by 2045, and through the WHO’s “Alliance for Transformative Action on Climate and Health” there are opportunities to work with other health services across the world to influence healthcare’s global supply chain.

Work on sustainable procurement, waste management, and the circular economy has the potential to make the largest contribution towards the net zero goal. This workstream relies on joint working and expertise from NHS Scotland National Procurement, NHS Assure, Health Boards and other stakeholders.

In order to achieve our goals, NHS Scotland will need to work in partnership with its suppliers, changing the way it procures goods and the way it manages products and material on its sites and at the end of their useful life. Our strategy sets out the actions that we plan on taking. The following sections provide data which is available for 2021/22 and information on actions which have been taken.

7.1 Sustainable Procurement

During 2022/23, NHS National Procurement has engaged its suppliers and started to collate Climate Change Plans from around 40% of our top 100 suppliers, based on spend, and aims to reach 100% of these suppliers by the end of 2023.

NHS National Procurement has established a Sustainable Procurement Steering Group, which meets monthly, with a focus on identifying and progressing on social, environmental, and ethical considerations across all our procurement activities.

In July 2022, a Climate Change and Circular Economy Lead role in NHS National Procurement was created and appointed, with the aim to accelerate plans to move towards a net zero supply chain by 2040.

7.2 Circular economy

In 2021/22, the Scottish Government established an NHS circular economy programme. An early priority is the development of plans for reducing plastic use and ensuring that the plastics which are used by the NHS retain their value as a material instead of being recycled into materials of lower quality and functionality.

7.3 Waste Data

The NHS produces large volumes of waste. This includes clinical waste, which requires special disposal, and general waste. Table 7 below sets out the total amount of greenhouse gases emitted for NHS Scotland from the disposal of Health Board’s waste, as reported in Health Boards’ Annual Climate Change and Sustainability Reports 2021/22. The data for individual Health Boards can be found in the Annex. Over the last few years, there has been increased accuracy in the collection and reporting of data for clinical waste streams. In addition, reports and data are being obtained for a number of other waste streams. The Covid-19 pandemic also resulted in an increase in waste, particularly clinical waste.

There is also work underway to improve waste data collection, as this has been an area where there have been challenges. The table below sets out the current understanding, with the caveat that this is likely to change as data collection improves.

On 9 December 2022, NHS Scotland launched a waste management training package to help staff segregate and better manage the valuable resources in waste, such as high-quality plastic. This work was produced through a Short Life Working Group of Waste Management Officers and led by NHS Assure. It is the first national training package that has ever been in place for NHS Scotland. The aim of the training is to raise awareness of waste management within NHS Scotland and ensure there is understanding of the legal requirements for the handling, segregation, storage, and disposal of waste arising from NHS Scotland activities. The training supports national waste campaigns, which encourage the correct segregation of clinical waste, and builds on previous work on the Scottish Health Technical Note 3 on Waste in 2013 and the Waste Management Action Plan 2016-2020.

Throughout this reporting period, NHS Scotland Health Boards have continued to make use of the ‘Warp-it’ portal, which facilitates the transfer of goods such as office furniture and equipment that is no longer required by organisations from around the UK. This supports reuse of products, avoiding waste, and keeps products in the economic value chain for longer. Re-use has a significant carbon benefit as it avoids the carbon emissions associated with the manufacture and supply of new products, as well as avoiding the impacts associated with waste disposal.

7.4 Small Business Research Initiative on Reusable Personal Protective Equipment

The unprecedented use of PPE during the pandemic, and a reliance on single-use products, has resulted in a significant environmental issue around PPE.

To help make improvements to future PPE provision, the Scottish Health and Industry Partnership Group launched a Small Business Research Initiative (“SBRI”) in 2021, funded by the Scottish Government and Transport Scotland.

The aim of the SBRI, which was launched virtually in March 2021 by the Minister for Business, Trade and Enterprise, Ivan McKee MSP, was to develop solutions that:

• aid prevention or reduce the spread of droplet and airborne biological hazards, thus reducing the need for PPE;
• reduce NHS staff reliance on single use disposable PPE; and
• allow the return of clinical procedures which are currently considered high risk because of their aerosol generating nature.

The SBRI was run by NHS Tayside, with seven companies being selected following open competition. Six of these progressed to the end of the first stage of the SBRI, which concluded in January 2023. NHS Tayside created a Test Bed for the assessment and evaluation of reusable PPE, along with technologies to assist in decontamination of the environment, to co-create and co-develop findings that could be adopted into clinical practice. Test beds offer real time access to professionals, varied clinical environments, and processes to determine how best to meet needs and create impact.

The SBRI Stage 1 helped develop products but did not take them as far as becoming medically and commercially approved. The SBRI highlighted some of the key issues that both companies and NHS Boards in Scotland face when wishing to introduce and procure reusable PPE. One of the main issues with face protection is the decontamination of the PPE, and the need for nationally adopted standards for this. Also, it became clear that meeting decontamination standards is not the only relevant criteria, and there is a need for a wider choice of well-designed and reusable PP3 level protection. This includes provision of customised face masks for staff who have difficulty fitting into standard mask fittings. At this stage, the market does not provide customised reusable masks that meet all relevant criteria, and further SBRI stages to develop reusable masks remain an option. These would depend on agreement by both NHS Tayside innovation and any companies involved.

In terms of decontamination devices, the overall conclusion was that no specific technology showed comprehensive evidence of efficacy and safety within healthcare environments beyond that of high-efficiency particulate air filter (HEPA) based systems. As the market already provides several options for decontamination, no current need for a further SBRI stage was felt to be required. If healthcare facilities wish to use other technology, the manufacturer must unequivocally prove safety and efficacy equal to decontamination standards.