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

Report for 2021 to 2022 providing information on; greenhouse gas emissions arising from the operations of NHS Scotland, actions which have been taken or are underway to reduce NHS Scotland’s greenhouse gas emissions and environmental impact, and actions to adapt to climate change.

1. Introduction

The planet is facing a triple crisis of climate change, biodiversity loss and pollution because of human activities breaking the planet’s environmental limits. Healthcare systems contribute to the crisis through the use of resources and generation of pollution, waste and greenhouse gas emissions.

This Annual Climate Emergency and Sustainability Report for NHS Scotland 2021/22 is the first to reflect the scope and aims of the NHS Climate Emergency and Sustainability Strategy published in August 2022. Its main purpose is to provide information on:

  • greenhouse gas emissions arising from the operations of NHS Scotland
  • actions which have been taken or are underway to reduce NHS Scotland’s greenhouse gas emissions and environmental impact
  • actions to adapt to climate change.

The time-period covered is the financial year from April 2021 to March 2022. However, in some cases activity has been included that took place following March 2022, following the publication of the NHS Climate Emergency and Sustainability Strategy in August 2022.

The World Health Organisation recognises that climate change is the single biggest health threat facing humanity. Health organisations have a duty to cut their greenhouse gas emissions, the cause of climate change, and influence wider society to take the action needed to both limit and mitigate the impacts of climate change, as well as adapt to its impacts. More information on the profound and growing threat of climate change to health can be found here: www.who.int/news-room/fact-sheets/detail/climate-change-and-health

1.1 Health Board Annual Reports

This report provides an overview of progress made and is informed by national data and more detailed Annual Reports prepared by individual Health Boards. Each Health Board’s Annual Climate Emergency and Sustainability Report should be available on its website.

1.2 Leadership

Making the level of progress needed with climate and sustainability action requires the support and energy of senior leaders within both Health Boards and the Scottish Government.

On 9 November 2021 at COP26 in Glasgow, the Cabinet Secretary for Health and Social Care, Humza Yousaf MSP, committed NHS Scotland to the COP26 Health Programme – to becoming a climate resilient and low carbon, sustainable health service.

The COP26 Health Programme, which was led by the UK government as the President of COP26, the World Health Organization and Health Care Without Harm, is now known as the Alliance for Transformative Action on Climate and Health (ATACH). Over sixty countries including the United States, Spain and Germany have signed up to its aims. More information is available at: Alliance for action on climate change and health (ATACH) (who.int)

On 10 November 2021, the Scottish Government issued a new policy for NHS Scotland on the Climate Emergency and Sustainable Development (DL 2021 38). The policy sets out aims and associated targets for NHS Scotland to work towards. It brought forward NHS Scotland’s target date for reaching net-zero from 2045 to 2040, in recognition of the need for the public sector and the health service to show leadership in moving more quickly to cut greenhouse gas emissions. It also outlined that each NHS Scotland body must take action to influence a reduction in those greenhouse gas emissions which are linked to its activities but are from sources which it does not own or control such as its supply chain and staff, patient and visitor travel. This is to maximise NHS Scotland’s contribution to reducing Scotland and the supply chain’s emissions to net-zero by 2045. The policy is available here: A policy for NHS Scotland on the climate emergency and sustainable development.

In March 2022, the NHS Scotland Climate Emergency and Sustainability Board was established to oversee the development and implementation of NHS Scotland’s strategy. It is chaired by the Chief Medical Officer for Scotland and NHS Scotland’s Chief Operating Officer, and currently meets every two months.

In August 2022, the NHS Scotland Climate Emergency and Sustainability Strategy was published setting out actions to be taken to help achieve NHS Scotland’s climate and sustainability aims and targets. The strategy is available here: NHS Scotland climate emergency and sustainability strategy: 2022-2026 - gov.scot (www.gov.scot)

In December 2022, NHS Scotland became a member of Healthcare Without Harm’s Global Green Hospitals network; an international community of hospitals, healthcare facilities, health systems, and health organisations working to achieve measurable outcomes improving sustainability at their facilities while promoting environmental health in their communities. Healthcare Without Harm’s website can be found here: Health Care Without Harm (noharm-europe.org)

The Cabinet Secretary for Health and Social Care, Humza Yousaf, launched the NHS Scotland Climate Emergency and Sustainability Strategy 2022 to 2026 during a visit to the Balfour Hospital in Orkney. Scottish Government Ministers have continued to provide leadership to the work throughout this reporting year, carrying out a number of engagements since August 2022, including:

During Scottish Climate Change Week (26 September – 2 October 2022), the Cabinet Secretary for Health and Social Care visited Douglas Medical Practice in Dundee to hear about work to improve patient outcomes and support the use of more environmentally friendly inhalers for asthma and Chronic Obstructive Pulmonary Disease (COPD).

The Minister for Public Health, Women’s Health and Sport also visited Raigmore Hospital during Climate Week to highlight work undertaken to improve operating theatres as part of Raigmore Hospital’s Green Theatres Project.

To achieve the ambitions in the strategy, including net-zero emissions by 2040, it is necessary to exchange knowledge with both domestic and international partners. This is to help us learn from the work of other countries, to share best practice in areas where Scotland is leading and to work together on common challenges. Working links have been established with colleagues across the UK and we are working with partners internationally.

1.3 Greenhouse gas emissions

NHS Scotland aims to become a net-zero organisation by 2040 for the following sources of greenhouse gas emissions:

  • building energy use
  • owned and leased fleet fuel use
  • fluorinated gases and anaesthetic gases
  • purchased energy use (electricity, heat, steam)
  • energy transmission and distribution
  • waste
  • water consumption
  • waste water treatment
  • business travel, including the use of grey fleet

NHS Scotland also aims to maximise its contribution to Scotland and its supply chain achieving net-zero emissions by 2045. This covers the following sources which the NHS does not control but which it can influence:

  • supply chain
  • staff commuting
  • patient and visitor travel

In 2021/22, three Health Boards piloted the development of Net-Zero route maps – NHS Ayrshire and Arran, NHS National Education for Scotland and NHS Shetland. This approach, funded by the Scottish Government, was rolled out to the remaining nineteen Health Boards in 2022/23. These reports are being analysed and further information on them will be provided in the annual report for 2022/23.

Table 1 below sets out greenhouse gas emissions within the 2040 target by source produced between financial years 2019/20 and 2021/22 by the Health Boards that make up NHS Scotland. This data is compiled from different sources including – the National Energy Management System, Public Health Scotland prescribing data, medical gas supplier data and each Health Board’s Annual Report.

Table 1 also shows an estimate of how much carbon is naturally captured by the outdoor estate at two Health Boards, by soil and plants growing on it.

More detail on the emissions source in table 1 are provided in subsequent sections of the report. There is still work to be done to improve our understanding of NHS Scotland’s carbon footprint and work will continue to promote best practice throughout NHS Scotland to ensure reductions are made as quickly as possible. In terms of the current data being reported, confidence levels are high in the accuracies of the emissions relating to buildings, inhalers and medical gases. However, further work is needed to gain a more accurate understanding of other sources of emissions, particularly significant areas such as supply chain emissions, travel and waste.

NHS Scotland is therefore working to improve the comprehensiveness and accuracy of its greenhouse gas emission reporting. In future years, we intend to add more categories of emissions to this report such as staff, patient and visitor commuting as calculations methods are agreed and implemented. In addition, future years may show apparent increases in some categories of emissions which are in fact due to better reporting rather than actual increases, as well as indirect increases in emissions due to increased renewable infrastructure and construction on site. In this report, examples include non-medical F gas increases due to improved data capture and reporting. Additionally, the figure for carbon sequestration in the table relates to only two territorial Health Boards – comparable figures have not yet been calculated for other Health Boards, but it is anticipated that they will be included in future years.

Table 1 - NHS Scotland 2040 Net-Zero Target Emissions 2019/20 to 2021/22
Amount of greenhouse gas (tonnes of CO2 equivalent) (n) = number of HBs reporting Percentage change since 2019/20 Data Source
Emissions Source 2019/20 2020/21 2021/22
Building Energy Use 451,161 440,710 422,687 - 6% NHS NSS – National Energy Management System
Non-medical F-gas use 140 (6) 1,270 (6) 5,487 (9) Increase 3,819% Health Board Climate Emergency and Sustainability Reports – 2021/22
Medical gases 32,047 26,511 26,832 - 16% Scottish Government
Metered dose inhaler propellant 84,844 78,860 83,513 - 2% Scottish Government
NHS fleet use and business travel 32,307 33,632 36,556 Increase 13% Health Board Climate Emergency and Sustainability Reports – 2021/22
Waste 3,115 (14) 3,333 (15) 6,271 (16) Increase 101% Health Board Climate Emergency and Sustainability Reports – 2021/22
Water 3,397 (16) 1,505 (14) 1,142 (15) - 66% Health Board Climate Emergency and Sustainability Reports – 2021/22
Carbon sequestration 0 (0) 0 (0) 1,027 (2) - Health Board Climate Emergency and Sustainability Reports – 2021/22
Greenhouse gas emissions minus estimated carbon sequestration 607,010 585,822 585,515 - 4%
Figure 1: NHS Scotland 2040 Net-Zero Target Emissions 2019/20 to 2021/22 (Sources as per Table 1)

Declining emissions in greenhouse gas emissions minus carbon sequestration, medical gases and building energy use. Small increase in emissions from metered dose inhaler propellant, water and waste. No change in emissions from carbon sequestration.

1.4 National Sustainability Assessment

NHS Scotland has developed a National Sustainability Assessment Tool (NSAT), which all Health Boards have initially used on an annual basis and will move to a biennial basis from 2024/25. This benchmarks their progress across sixteen different areas of sustainability and demonstrate how local actions are contributing to achieving the United Nations Sustainable Development Goals.

The NSAT replaced the Good Corporate Citizenship Assessment Model (GCCAM) which was widely used by NHS providers and commissioners in England and NHS Health Boards in Scotland from 2008. All assessments for 2021/22 have been reviewed by NHS Assure and an external auditor to ensure consistent, evidence-based scoring. Due to the pressures of the Covid-19 pandemic, reviews of 2020/21 assessments were only carried out on request.

The average 2021/22 score for Health Boards that chose to have their assessments reviewed by NHS Assure in 2020/21 has increased from 49% to 53%. The average score for Health Boards who did not have their self-assessed scores reviewed in 2020/21 has decreased from 53% to 38%. The overall average 2021/22 score has decreased from 49% to 44%.

For 2022/23, the NSAT has been updated to reflect the NHS Scotland Climate Emergency and Sustainability Strategy and other changes to policy, targets, and legislation.

The NSAT scores for 2021/22 can be found in the Annex.


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