NHS Scotland - climate emergency and sustainability: annual report 2025
This year’s report shows how NHS Scotland is working to reduce its environmental impact and adapting its infrastructure and services to address the risks presented by climate change. It also illustrates some of the wider benefits which work in this area offers.
Introduction
NHS Scotland consists of 22 health boards, responsible for approximately 1000 sites, some of which are incredibly challenging to transition to low-carbon energy systems, given their operational requirements. NHS emissions sources include building energy, medical treatment, and the use of goods and materials.
The highest direct sources of greenhouse gas emissions for NHS Scotland come from energy used for heat and power in NHS buildings. This year’s report shows NHS Scotland continuing to make sustained progress in reducing its building emissions. There has been an 11% reduction between 2019/20 and 2024/25. However, further reductions may be more difficult. The reduction in emissions has owed much to the decarbonisation of the grid and a reduction in electricity consumption, neither of which are expected to proceed at the same rate going forward. In fact, electricity usage is expected to rise as the electrification of heating and transport proceeds, with a corresponding fall in the use of gas and other fossil fuels.
NHS Boards, therefore, must find innovative solutions to reduce their energy emissions. This can include private wires to renewable energy sites and connecting to local heat networks. Where possible the Scottish Government is contributing funding to support innovative projects, especially to help decarbonise those sites with the biggest energy emissions.
The electrification of the fleet continues to make sure progress. As of April 2025, NHS Scotland’s car fleet was 55% electric, and its light commercial vehicle (LCV) fleet was 35% electric. This represents significant progress from 2023, when respective figures were 35% for cars and 16% for LCVs.
Emissions from N2O and Entonox in NHS Scotland fell by 29% between the baseline year of 2018/19 and 2024/25, and 13% between 2023/24 and 2024/25. Emissions from the volatile anaesthetic gases, desflurane, sevoflurane and isoflurane, were 1,129 tCO2e in 2024/25, dramatically down from over 10,170 tCO2e in the baseline year of 2017/18. Most of this fall in volatile gas emissions was a result of a reduction in the use of desflurane and switches to sevoflurane and isoflurane.
Inhalers are a significant contributor to medical climate change emissions gases, mainly because of the propellant gases they use, and are the second biggest source of NHS Scotland emissions covered by the 2040 net-zero target after building energy. Emissions from this source have fallen by 18% since 2022/23. Inhaler emissions come from pressurised Metered Dose Inhalers (pMDIs) used for asthma and other respiratory conditions. Seventy percent of pMDI emissions are due to salbutamol inhalers. Revised clinical guidance, with a primary aim of improving patient care, published in November 2024 removes salbutamol from mild and moderate asthma pathways, as discussed in the chapter on medical gases and inhalers. As implementation of this guidance progresses, a significant reduction in pMDI prescribing is expected across Scotland resulting in a significant reduction in CO2 emissions.
This report also discusses waste and the circular economy. It is estimated that approximately 60% of emissions generated by NHS Scotland come from the use of goods and materials, including medicines. NHS Scotland aims to reduce supply chain emissions across the health service to net zero by 2045 through effective, environmentally informed procurement, efficient use of goods and materials and minimisation of waste. Moving to a circular economy is a key tenet of Scotland’s sustainability and net zero policies, and can support supply chain resilience, helping to reduce price increases caused by material scarcity, critical raw material concerns and access risks.
The potential impacts of climate change underscore the importance of adapting our health system. NHS Scotland faces a broad range of climate related risks affecting the delivery of healthcare, challenging the reliability of infrastructure and operations, and posing risks to the health, safety and wellbeing of both patients and staff. To address these challenges, NHS boards have developed Climate Change Risk Assessments (CCRAs), and Adaptation Plans for healthcare assets, identifying potential risks and outlining strategies to mitigate them. As of March 2025, 22 NHS boards had completed their CCRAs, and 18 have developed Adaptation Plans.
In addition, this report covers progress with caring for and improving NHS Scotland greenspace. Smart use of natural features can help provide solutions for some of the problems posed by expected climate change scenarios, such as overheating and high levels of rainfall. For instance, trees and blue green infrastructure can be used to attenuate rainwater surge or provide shade and temperature moderation.
The provision and development of greenspaces can also offer opportunity for Scotland to achieving its legally binding biodiversity targets, an action critical in responding to the global biodiversity crisis. NHS Scotland is legally obliged to further the conservation of biodiversity while carrying out their responsibilities under the Nature Conservation (Scotland) Act 2004. The extensive NHS Scotland estate presents an invaluable opportunity to improve outdoor environments and healthcare experience by staff and visitors, while contributing to wider local community place making initiatives and providing access to active travel opportunities.
Details of climate emergency and sustainability projects carried out by health boards can be found in their annual climate emergency and sustainability reports on their websites.
The production of this report has benefitted from contributions from those within the NHS Scotland Action Programme, including NHS Scotland Assure Property, Sustainability and Capital planning, NHS NSS National Procurement, the National Green Theatres Programme, and NatureScot.