Annual NHS Scotland Climate Emergency & Sustainability Report 2024

Introduction

NHS Scotland aims to reduce its greenhouse gas emissions to net zero by 2040 and achieve net-zero emissions from its supply chain by 2045.

“The most pressing reasons for urgent climate action are the impacts not in the future, but right now, on health. The climate crisis is a health crisis”[1] Most people nowadays are aware of the need to create more environmentally friendly systems and processes. Key issues such as greenhouse gas emissions, plastic waste, threats to our wildlife and the threats to human health from pollution, are often leading news stories.

More often overlooked are the tremendous efforts being made, across all areas of society, to find ways of working, living and flourishing within the constraints of an environment that is susceptible to human impact.

Health care and services in Scotland and across the globe have a substantial environmental impact, either directly from carbon emissions released from burning fossil fuels for heat and power, or indirectly, through their use of goods and materials. This report highlights achievements by NHS Scotland towards providing environmentally sustainable care and becoming a net-zero health service by 2040. It shows the main areas of work being taken forward by NHS Scotland to reduce the negative environmental impacts of healthcare delivery, and to make positive changes to our local environments, benefitting the health and wellbeing of local communities as well as improving biodiversity.

It is encouraging to see that in the areas of building energy, which is the largest single source of greenhouse gas emissions for NHS Scotland, and transport and medical gases, significant progress is being made by our Health Boards. For building energy, much more now needs to be done, but the achievements so far should make us hopeful in realising that further progress can be made.

The second biggest direct source of greenhouse gas emissions in the NHS is the propellant used in inhalers. As detailed in the report, measures are now being promoted to support better patient healthcare while reducing environmental impact; a good example of work which emphasises patient empowerment and self-care, lean clinical pathways and low-carbon alternatives.

This year’s report shows how NHS Scotland is working to reduce its environmental impact and adapting its infrastructure and services to the address risks presented by climate change. It also shows that many changes the NHS seeks to deliver have other potential benefits in the short and medium term. These include improving health outcomes, clinical services and financial performance. The report includes data for the financial year 2022-2023 (April 2022 to March 2023) and provides an update on activity which has been carried out since the publication of the last report (published in July 2023).

The year 2022-2023 was the first in which objectives relating to climate change and the environment were put into Scottish Health Boards’ Annual Delivery Plans and Medium Term Plans, ensuring that environmental sustainability and adaptation become core business for our Health Boards.

Emissions Overview

NHS Scotland consists of 22 Health Boards, responsible for around 1000 buildings, some of which are incredibly challenging to transition to low-carbon energy systems, given their operational requirements. Its emissions sources include building energy, medical treatment, and its use of goods and materials.

During the year 2022-2023:

• emissions from energy to heat and power buildings fell again (from 427,000 tCO₂e in 2021-2022 to 407,000 tCO₂e);
• the NHS’s electric fleet continued to expand with electric vehicles now making up 33% of NHS cars; and
• NHS Scotland won the European Sustainable Healthcare Project of the Year award for its work on reducing emissions from medical gases, a project which was started by the grassroots group Green Anaesthesia Scotland and supported by the NHS National Green Theatres Programme.

The highest direct sources of greenhouse gas emissions for NHS Scotland come from energy for heat and light in NHS buildings. Our goals remain to:

• reduce greenhouse gas emissions from our buildings by at least 75% by 2030 compared to a 1990 baseline; and
• to use renewable heating systems by 2038 for all NHS-owned buildings; and
• for all our estate to have net-zero emissions by 2040 or earlier.

NHS Scotland deserves credit for collectively meeting all of its annual energy targets relating to heating and powering buildings, but that is expected to become more difficult going forward. This is because much of the reduction in emissions up until now has been due to the decarbonisation of the grid and a reduction in electricity consumption, which are not expected to proceed at the same rate going forward. Boards, therefore, must find innovative solutions to reduce their energy emissions.

The second biggest source of NHS emissions included in the 2040 net-zero target is from propellant inhalers, that is, “pressurised Metered Dose Inhalers” (pMDIs), used for asthma and other respiratory conditions. There are alternatives to propellant inhalers such as “Dry Powder” inhalers (DPIs) and “Soft Mist” inhalers (SMIs). Where appropriate, and informed by patient needs, using these can lead to improved treatment.

The use of goods and materials, including medicines, is estimated to account for approximately 60% of emissions generated by NHS Scotland. We want to maximise our contribution to reducing supply chain emissions across health services to net zero by 2045 through effective, environmentally informed procurement and minimisation of waste.

The table below shows the progress Health Boards have made toward net zero across a number of areas. We are working to better quantify emissions and table footnotes give details of the effect of some of this work. Apparent increases in emissions for some categories such as non-medical F-gases, fleet and business travel, may be due to more accurate reporting rather than actual increases.

Table 1: NHS Scotland 2040 Net-Zero Target Emissions 2019-2020 to 2022-2023

Where not all Health Boards have reported, the number of Health Boards reporting is given in brackets after the emissions figure.

(i)These figures do not include Diesel Engine Road Vehicle Fuel (DERV). The figure for DERV was included in the 2021/22 report but should not have been, because DERV is mainly used for vehicles, not building energy. Please note also, the figures for building energy in the above table differ from those in Part 2, Table 1a, which was derived from the individual NHS Board climate change and sustainability reports submitted at the start of 2024. Building energy usage reported in the above table includes well-to-tank emissions.

(ii)The figure given in the 2021/22 report was 422,687. However, that figure has been revised upwards following an internal review.

(iii) This large percentage may be due to better reporting.

(iv) These vary from the figures given in the 2021/22 report due to a recalculation, which is based on the exclusion of Soft Mist Inhalers from the original pMDI calculations.

(v) Not all Boards report transport data, so the real figures will be higher than those reported in this table. The increase in reporting over time, particularly business travel, partly accounts for the 30% increase between 2019/20 and 2022/23.