NHS Scotland climate emergency and sustainability strategy: 2022-2026

Our Ambition and Approach

'Climate change poses a catastrophic threat to humanity and the natural systems that underpin our lives. It is obvious that tackling climate change will have a positive impact on human health'.^[2]

"We are at a crossroads. The decisions we make now can secure a liveable future. We have the tools and know-how required to limit warming".^[3]

Introduction

4. The need to act to address the triple planetary crises of climate change, pollution and biodiversity loss is clear and pressing. In recognition of this, NHS Scotland became the first national health service in the UK to commit to becoming a net-zero organisation.^[4] Since then, a further 18 countries have committed to net zero health service targets and 52 countries globally have committed to low carbon, sustainable health care systems.

5. But like all sectors of society, we need to accelerate our efforts to cut our greenhouse gas emissions and become environmentally sustainable. We have therefore brought forward our target date for achieving net-zero emissions from 2045 to 2040. Our efforts to reduce emissions need to be as rapid as possible, since earlier mitigation reduces the scale of change required and, as climate breakdown progresses, impacts on critical infrastructure will impede emissions reduction efforts. We recognise that, where possible, changes should be prioritised and action initiated before 2025-2030 to ensure effective delivery. The cost of inaction or delay will dwarf the cost of action on climate and biodiversity, and increase the burden of chronic disease and the need for increasingly urgent actions to limit emissions.^[5]

6. The case for the health service to act is about more than simply playing our part. The threats to human health from the climate emergency, both in Scotland and globally, are so serious that climate change has been described by the Lancet Commission on Managing the Health Effects of Climate Change as "the biggest global health threat of the 21^st century".^[6]

7. At the same time, many of the actions needed in response to the climate emergency and the environmental crisis have positive health impacts if delivered with that intent. Cutting emissions, enabling active travel, restoring biodiversity and improving air quality can prevent diseases such as asthma, pneumonia, heart attacks and stroke. Well-insulated buildings can save lives and prevent illnesses as well as reducing energy consumption and fuel poverty. Eliminating medicine residues from wastewater prevents harm to biodiversity and limits the development of antimicrobial resistance (AMR), one of the most serious threats to our ability to treat illness. The direct and indirect health benefits are so great that tackling climate change has also been described by the Lancet Commission as "the greatest global health opportunity of the 21^st century".^[7]

8. The Scottish Government is committed to a just transition away from a fossil-fuel based economy. This means making the journey towards a net zero and climate resilient economy in a way that delivers fairness and addresses inequality and poverty. Climate change, pollution, biodiversity loss, sustainability, health and health inequalities are inextricably linked. Tackling the climate emergency in a just and fair way will avoid making health inequalities worse and has the potential to reduce them.

9. As an organisation dedicated to improving and protecting physical and mental health and wellbeing, our National Health Service must be in the vanguard of efforts to tackle the climate emergency and the environmental crisis.

10. NHS Scotland has shown throughout the Covid-19 pandemic that it can act quickly in a crisis. The climate emergency and environmental crisis requires urgent action.

Our Aims

11. Our ambition is to become a service which is both environmentally and socially sustainable. A health service that improves the environment, opportunities, life chances, health and wellbeing of every citizen in our country. One that fully contributes to a more cohesive, resilient and net-zero society, and contributes to the Care & Wellbeing Portfolio's mission to improve population health, population wellbeing and reduce health inequalities. To do this, NHS Scotland aims to collectively:

• ensure that we, as an integral part of our communities, contribute to the achievement of the UN SDGs and national outcomes for health
• become a net-zero greenhouse gas emissions health service by 2040 or earlier
• make our assets and activities more resilient to the impacts of a changing climate, particularly extreme weather events
• establish a culture of stewardship, where we safeguard and responsibly use resources to provide environmentally sustainable healthcare
• establish NHS Scotland as part of the circular economy through designing out waste and pollution, keeping products and materials in use and contributing to the regeneration of natural systems
• increase our contribution to tackling the ecological emergency and restoring biodiversity

12. To achieve these aims, we need the help of everyone across the whole of NHS Scotland. Many are already taking action to help create a more sustainable NHS and others have great ideas to share. We need to support the energy and enthusiasm of our people and give them the resources and backing they need to make the changes our communities and the world need. We need to build on the great work which has already been done and accelerate activity to scale it up across the whole of NHS Scotland.

Delivering the UN SDGs and a Just Transition

13. Sustainable development, the concept that human needs must be met within the limits of natural systems, has a crucial role to play in ensuring a better quality of life for everyone.

14. In 2015, all UN Member States adopted the 2030 Agenda for Sustainable Development; a shared blueprint with the 17 SDGs at its heart. The SDGs are a call for action by all countries to promote prosperity while protecting the planet. They recognise that ending poverty must go hand-in-hand with strategies that build economic growth and address a range of social needs including education, health, social protection, and job opportunities, while tackling climate change and protecting the environment.

15. The Scottish Government has embedded the SDGs within the current National Performance Framework (NPF). The NPF sets out a vision for Scotland across a range of social, economic and environmental factors. It highlights the need for a 'whole system approach' to successfully deliver the national outcomes for health and recognises the important role that NHS Scotland has in helping to achieve this, ensuring quality healthcare services are available and accessible to all.

16. The Scottish Government is committed to working across all sectors of our society to deliver lasting action that secures a just transition to a climate resilient and net zero future. This means delivering on our social, economic and climate goals in a way that harnesses the opportunities and navigates the challenges that the transition to net zero presents across all sectors of the economy, including healthcare, to build a better and more equal Scotland.

17. To ensure an orderly, managed transition, Scottish Government has set out a National Just Transition Planning Framework with eight National Just Transition Outcomes.^[8] The Framework and Outcomes will allow a consistent and ambitious approach to planning, increasing our ability to achieve the transformational change necessary to meet our climate targets.

18. NHS Scotland is committed to supporting a just transition to net zero and progress on meeting the SDGs and national outcomes in Scotland. In addition to our commitment to living and working within the limits of the natural environment, our actions to create a sustainable health service are also informed by the following just transition principles:

• plan, invest and implement a transition to an environmentally and socially sustainable, climate resilient, health service in a way which builds on Scotland's economic and workforce strengths and potential

• create opportunities to develop resource efficient and sustainable approaches which help address inequality and poverty
• design and deliver low carbon and climate resilient investment and infrastructure making all possible efforts to create decent, fair and high value work

Figure 1 plain text version: The Sustainable Development Goals

• Goal 1: No Poverty
• Goal 2: Zero Hunger
• Goal 3: Good Health and Well-Being
• Goal 4: Quality Education
• Goal 5: Gender Equality
• Goal 6: Clean Water and Sanitation
• Goal 7: Affordable and Clean Energy
• Goal 8: Decent Work and Economic Growth
• Goal 9: Industry, Innovation and Infrastructure
• Goal 10: Reduced Inequalities
• Goal 11: Sustainable Cities and Communities
• Goal 12: Responsible Consumption and Production
• Goal 13: Climate Action
• Goal 14: Life Below Water
• Goal 15: Life on Land
• Goal 16: Peace, Justice and Strong Institutions
• Goal 17: Partnerships for the Goals

Figure 2 plain text version: The National Performance Framework

Our Purpose:

• To focus on creating a more successful country with opportunities for all of Scotland to flourish through increased wellbeing, and sustainable and inclusive economic growth.

Our Values:

• We are a society which treats all our people with kindness, dignity and compassion, respects the rule of law, and acts in an open and transparent way.

National Outcomes:

• We have a globally competitive, entrepreneurial, inclusive and sustainable economy.
• We are open, connected and make a positive contribution internationally.
• We tackle poverty by sharing opportunities, wealth and power more equally.
• We live in communities that are inclusive, empowered, resilient and safe.
• We grow up loved, safe and respected so that we realise our full potential.
• We are well educated, skilled and able to contribute to society.
• We have thriving and innovative businesses, with quality jobs and fair work for everyone.
• We are healthy and active.
• We value, enjoy, protect and enhance our environment.
• We are creative and our vibrant and diverse cultures are expressed and enjoyed widely.
• We respect, protect and fulfil human rights and live free from discrimination.

Working in partnership

19. NHS Scotland cannot deliver its sustainability aims on its own. We also need to work closely with local communities, local authorities, patients, health care unions, other public bodies, third sector organisations, the private sector and academia to achieve them. We will actively engage in existing forums for collaboration and assist in creating new ones where they are needed. Some examples of where collaboration are needed is the creation of district energy networks and the implementation of sustainable transport to NHS sites.

20. Actions to improve the sustainability of our NHS will be delivered by Health Boards and Integrated Joint Boards working in partnership with Community Planning Partnerships and Regional and Local Resilience Partnerships and the communities they serve. This strategy provides the vision and objectives for the NHS setting out high level requirements and examples of good practice, recognising that action on the ground will depend on local circumstances and the specific sustainability challenges and opportunities that individual health and care organisations face.

Our role as an anchor organisation

21. Anchor organisations are one of the specific focuses of the Place & Wellbeing programme within the Scottish Government's Care & Wellbeing Portfolio. We are committed to acting for the benefit of the local communities we serve and recognise that we can positively contribute to local areas in many ways beyond providing healthcare. Our strategy will make a difference to local people including our staff through working more closely with our local partners to use our buildings and spaces for social benefit, providing opportunities for recreation and physical activity, improving access to high quality outdoor space, making local sourcing possible, and reducing our environmental impact.

22. We also recognise the NHS's role as an anchor organisation for Scotland as a whole. We recognise that there is the potential for our efforts to reach net-zero to provide an exemplar for other sectors of the country.^[9] As anchor organisations, NHS bodies have an unrivalled opportunity to model the sustainability goals around fair employment, gender equality and sustainable communities and in so doing tackling inequalities.