NHS Scotland climate emergency and sustainability strategy: 2022-2026

Executive Summary

Within the NHS Scotland Climate Emergency and Sustainability Strategy there are five main themes, each with associated actions and in some places targets to achieve to support our overall net-zero ambitions.

Sustainable Buildings & Land: This part of our strategy focuses on the actions we will take to help create truly sustainable NHS buildings and land.

It covers the following topics:

• reducing our building greenhouse gas emissions
• adapting our estate to climate change impacts
• embedding good environmental stewardship of our services, buildings and infrastructure assets
• reducing our waste and managing it better
• valuing, protecting and managing our greenspace
• the sustainable future development of our NHS healthcare estate

Building energy use makes up the biggest proportion of our direct greenhouse gas emissions. Limiting these emissions will have health and wellbeing benefits for our communities as well as helping Scotland's transformation to a net-zero society and limiting the harm to our environment. Increasing energy prices, particularly rising gas prices, have put the need to make the NHS estate more energy efficient into sharp focus.

Our goal is to reduce greenhouse gas emissions from our buildings by at least 75% by 2030 compared to a 1990 baseline, 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 where possible.

In light of the Scottish Government's aim for publically owned buildings to use zero emissions heating by 2038, this strategy also commits NHS Scotland's new facilities to either be designed to use renewable heating systems from the beginning of their use or to have a clear plan to do so by 2038 where a renewable heating system is not currently practicable.

It is essential that we act to both reduce emissions to net-zero and adapt in ways that maximise positive environmental and health co-benefits. Health Boards are making good progress with assessing climate risks and preparing adaptation plans but these need to be integrated into other strategies and risk management processes.

NHS Scotland is a custodian of significant areas of greenspace and we are committed to working with our local communities and other partners to develop and manage this public asset in a way which improves public health, reduces health inequalities and helps to address biodiversity loss and the climate emergency.

Sustainable Travel: The Sustainable Travel chapter covers the following topics:

• Reducing the need to Travel
• Promoting Active Travel
• Promoting Public and Community Transport
• Decarbonising our fleet and business travel
• Climate Change and Access

Seventeen per cent of journeys in Scotland in 2019 were under 1 km, and more than half (54%) were under 5 km – these shorter trips offer a real opportunity for a significant shift to active travel.

NHS Scotland will support this shift. By making it easier to walk, wheel, cycle and take public transport to use NHS services, we will improve access for all, particularly those with low incomes, improve health and help tackle the climate emergency. By reducing the need to travel and supporting the shift to active travel and vehicles powered by renewables, we will help improve air quality and cut carbon emissions.

NHS Scotland seeks to find the right travel solutions for each of the communities we serve, maximising health and wellbeing through both the care we give and the way it is provided. The NHS will support the Scottish Government's ambition to create twenty-minute neighbourhoods – places where things that people need for everyday life are all located within a twenty-minute walking distance.

We want all our sites, including those non-NHS sites used by primary care services, to be easily accessible for staff, patients and visitors by public or community transport. Public transport is a more physically active way of travelling than private car and has a much lower environmental impact as it is more resource efficient. Where public transport is not a realistic option, we want community-led transport and lift-sharing to be available to help people access healthcare services.

We aim to remove all fossil-fuelled small and light commercial vehicles in the NHS fleet. We will also ensure all NHS small and light commercial vehicles are powered by renewable alternatives by 2025 and no longer buy or lease large fossil-fuelled vehicles by 2030. To support the transformation of our fleet, we will continue to install electric vehicle charging points throughout the NHS estate and collaborate across the public sector on charging infrastructure.

Many of the issues associated with transport and infrastructure disruption due to climate change are outside the control of NHS Scotland but can have a considerable impact on the delivery of care. It is therefore important that Health Boards work closely with infrastructure owners and managers, Integrated Joint Boards, local authorities and The Scottish Environment Protection Agency (SEPA) to understand the risks, especially for critical routes in remote rural areas where there are no alternative routes.

Sustainable Goods and Services: We need to reduce our demand for resources and avoid accumulating waste, we need to value the resources that we do consume by designing them to last, reusing them and recycling them when they reach the end of their useful life.

This section of our strategy focuses on our actions to:

• create circularity in our supply chains and reduce waste by maximising repair and reuse
• reduce the environmental and social impacts from our supply chains
• increase the resilience of our supply chain to climate change
• improve how we deal with equipment, material and goods at the end of their useful life

To become an environmentally and socially sustainable health service we need to embrace a circular economy, using our purchasing power to encourage our suppliers to cut their greenhouse gas emissions to net-zero and limit the negative environmental and social impacts of our supply chain. The harm caused by the over-use of resources is very real but it is often hidden from sight, and there is a role for everyone in the NHS in helping to reduce these impacts.

NHS Scotland purchases £2.5 billion worth of goods and services each year from around 8000 suppliers and much of the NHS's carbon footprint is created by the manufacture and supply of medicines, chemicals, equipment and other materials.

In making decisions about the goods we procure, we will choose products which have been designed for durability, can be repaired and upgraded, and can be recycled at the end of their useful life.

To maximise our impact, we will prioritise addressing the issues with the products with the highest environmental costs and those with the greatest risks of socially unsustainable practices. We will actively work with suppliers to improve their environmental and social sustainability.

The Scottish Government has established a NHS Scotland Circular Economy Programme to support the transition to more circular supply systems. Circular systems will play a pivotal role in enabling NHS Scotland to reach net zero. We need to review and change how we procure goods and services, ensure ancillary and support systems are in place to enable greater re-use and reprocessing and work with the supply chain to help suppliers evolve and change their business models.

We have established a programme of work to reduce the amount of PPE we use, increase the use of reusable Personal Protective Equipment (PPE) within NHS Scotland and increase those items that are recycled at the end of their use (both single use and multi-use items).

Finally, our aim is to ensure that we maintain security of supply and that this is resilient to extreme weather now and in the future. Health Boards should consider their supply chains within their Climate Change Risk Assessments (CCRAs) and Adaptation Plans and ensure that appropriate measures are included to maintain security of supply.

Sustainable Care: The way we provide care can have a major impact on both our communities and the environment and is key in our transition to a net-zero health service. By changing how we plan and deliver services we can empower people to have more control over their health and deliver rapid and long-lasting change which is environmentally sustainable, increases our contribution to good health and reduces health inequalities.

Our clinicians and staff must be at the heart of NHS Scotland's climate emergency response and our efforts to become an environmentally and socially sustainable health service. This part of our strategy sets out NHS Scotland's immediate priorities for delivering more sustainable care. It covers the following topics:

• Sustainable care pathways and green health activities
• Realistic Medicine
• Medicines
• Inhalers
• Medical gases
• Green theatres
• Supporting primary care

By supporting professionals to practise Realistic Medicine and deliver personalised care, practise shared decision making and tackle unwarranted variation in health, treatment and outcomes, NHS Scotland can reduce harm and waste and deliver better value care – better value for patients and for our health and care system.

We will develop a methodology for assessing the environmental impact of different models of care to take account of their environmental impact, including greenhouse gas emissions and the sustainable use of resources, and the environmental and health co-benefits of more sustainable care models when redesigning services.

Practising Realistic Medicine has become more important than ever. It will help to deliver greener and more sustainable care. It will help foster a culture where healthcare professionals take responsibility for the resources they use, practise shared decision making and tackle unwarranted variation in order to provide better value care – better value for patients and for our system.

We are developing our Clinical Decision Support tools and guidance to promote Shared Decision Making, inform patients about their treatment and medication and provide clinicians with up to date evidence based prescribing advice. Reducing wasted medicines has a double carbon benefit as it reduces upstream emissions in manufacturing and distribution and downstream emissions as fewer medicines need to be disposed of.

The propellant used in metered dose inhalers (MDIs) prescribed for asthma and chronic obstructive pulmonary disease (COPD) are powerful greenhouse gases with global warming potentials of 1430 or 3220 times greater than CO² depending on the type. Around 4.5 million MDIs were dispensed in Scotland in 2020/21. We therefore aim to reduce our emissions from inhaler propellant by 70% by 2028. At that point, we will review progress before setting further targets for inhaler propellant emissions on the path to net-zero.

Anaesthetic gases are potent greenhouse gases with global warming potentials far greater than carbon dioxide. These gases are made up of desflurane, isoflurane, sevoflurane and nitrous oxide. This is an area where rapid emissions reductions are possible. Reducing the environmental impact of anaesthetic gases is a priority. Key priorities include establishing multidisciplinary project teams within Health Boards to work towards zero emissions of anaesthetic gases at each acute site within their area, working to end use of desflurane and to support trials of volatile gas capture technology to determine its efficacy in real-world situations.

Our aim is for every NHS Scotland theatre to be a Green Theatre. To support Health Boards with this, a National Green Theatre Programme is being established to provide advice and guidance. Health Boards will adopt the learning from NHS Highland's Green Theatre Project.

Health Boards and Health and Social Care Partnerships will work closely together with each other and NHS independent contractors (General Practitioners (GPs), dentists, community pharmacies and optometrists) to both minimise the environmental impact of primary care services and maximise the benefits to health and the environment.

Sustainable Communities: This section of our strategy includes:

• Supporting health and wellbeing
• Building community resilience
• Engaging our communities

The growing threat to public health from the climate emergency increases the need for action. We all have a clear responsibility to respond in a way that nurtures good health for the population and the planet.

The climate emergency undermines the foundations of good health and deepens inequalities for our most deprived communities. The NHS touches every community in Scotland. We have a responsibility to use our abilities as a large employer, a major buyer, and one of the most recognised brands in the world – an 'anchor' organisation – to protect and support our communities' health in every way that we can. We will work together with our partners, including local authorities and Public Health Scotland, to bring sustainability, better health and fairness to all communities.

For people to stay healthy, we need to keep our planet healthy. Increasing scientific evidence shows that the climate and nature emergency is harming human health in a variety of ways. For example, the threat from air pollution (due to harmful emissions from transport and buildings), heat-related illness and mortality, increased prevalence of vector-borne disease, physical injuries and the mental health impacts associated with climate-related events such as flooding.

Rural and urban green spaces, such as parks, playgrounds, and gardens, can promote mental and physical health by reducing stress, supporting physical activity, and enabling people to come together. They can also help reduce exposure to the damaging effects of air pollution, noise, and excessive heat. Good access to high quality services, active travel options and sustainable, resilient public transport also contribute to health, and we will work to support this both on our own sites, and beyond them.

We will work with our partners to support and encourage improvements in planning, housing and transport that recognise the potential impacts of climate change on health and to ensure that different population groups in society are not further disadvantaged.

The actions set out in this strategy will also help to support the necessary behavioural changes needed by our staff, patients and local communities in contributing to social and environmental sustainability and reaching net-zero.