NHS Scotland - climate emergency and sustainability: annual report 2025

Part 1 - Progress Update On Emissions And Waste Reduction

Emissions Overview

The NHS Scotland Climate Emergency & Sustainability Report 2024 published emissions figures for financial year 2022/23. This year’s report includes figures for the year 2023/24 and figures for 2024/25 for the categories where they are currently available. The remaining figures for 2024/25 will be published in future reports.

Table 1: NHS Scotland 2040 Net Zero Target Emissions 2019/20 to 2024/25

Emission source	2019/20 (tCO2e)	2023/24 (tCO2e)	2024/25 (tCO2e)	% change 23/24 – 24/25	% change 19/20 – 24/25	Data Source
Building Energy Use including Well to Tank Emissions (i)	*451,00 0	410,000,	403,000	- 2%	-11%	NHS NSS – National Energy Management System
Medical gases(ii)	*29,000	22,000	19,000	-13%	-35%	Scottish Government
Metered dose inhaler propellant	93,247	84,000	74,000	-12%	21%	Public Health Scotland
NHS fleet use and business travel	*36,000	45,000	N/A	N/A	N/A	NHS Assure
Waste	3,000 (13)(iii)	8,000 (18)(iii)	N/A	N/A	N/A	Health Board Reports
Water	3,000 (16)(iii)	2,000 (19)(iii)	N/A	N/A	N/A	Health Board Reports
Total Recorded Emissions	522,000	571,000	N/A	N/A	N/A	-
Carbon sequestration	0	1,000	N/A	N/A	N/A	Health Board Reports
Net Emissions	522,00	570,000	N/A	N/A	N/A	-

N/A=Not available at time of writing.

*Please note that figures in bold against an asterisk differ from those previously reported for 2019/20. They have been updated following recalculation with improved data.

(i)These figures do not include Diesel Engine Road Vehicle Fuel (DERV). DERV was included up until the 2021-2022 report, but in fact is mainly used for vehicles, not building energy.

(ii) Medical gases include volatiles, N₂O and Entonox.

(iii) Where not all health boards have reported, the number of health boards reporting is given in brackets after the emissions figure.

Building Energy

Introduction

Building energy consumption for heat and power remains the largest contributor to the emissions covered by NHS Scotland’s 2040 net zero target. The diversity of building types in NHS Scotland’s estate presents significant technical and financial challenges for decarbonisation, with the age and state of many buildings presenting issues. We have, however, seen some significant success. For example, NHS Orkney became the first Health Board to complete the installation of renewable heating systems in all its buildings.

Energy Intensity Drivers:

• Main sites often operate 24/7 with high energy demands due to activities including clinical cooling, sterilisation, and air handling.
• Geographic spread also affects fuel choice availability.

This creates a complex landscape in which “one-size-fits-all” decarbonisation strategies are not viable. Electricity network capacity constraints remain a challenge across most acute hospital sites.

Progress Since 2015/16

Despite these challenges, NHS Scotland has made meaningful progress in reducing its building energy emissions:

• Reductions in energy use have saved the NHS £181 million in energy costs since 2015/16.
• Overall emissions have decreased by 32% since 2015/16 partly due to fuel switching, optimised system use and energy efficiency measures.
• Electricity related emissions have dropped dramatically by 65%, largely due to grid decarbonisation (reduced carbon intensity per kWh).
• Fossil fuel emissions (gas, oil, LPG) have only marginally decreased by 2%, indicating persistent reliance on combustion-based heating.
• This underscores the importance of prioritising heat decarbonisation, especially in fossil fuel reliant buildings. It should be noted that recent electricity unit prices are £0.278/kWh compared to gas unit prices at £0.064/kWh, influencing the continued use of fossil fuel energy systems.
• There is a small but increasing level of renewable energy generation across multiple NHS Scotland sites. Work is being conducted to improve data reporting for these so renewable power generation can be included in future annual reports.

Table 2: NHS Scotland Building Energy Emissions – Last three years compared to 2015/16 baseline

Overall Building Energy Use Emissions (tCO2e)	2015/16	2022/23	2023/24	2024/25	% Change 2015/16 - 2024/25
Building fossil fuel use	311,000	309,000	306,000	304,000	-2.0%
District heat networks and biomass	9,000	3,000	3,000	3,000	-67%
Electricity generation transmission and distribution	271,000	95,000	101,000	96,000	-65%
Total	591,000	407,000	410,000	403,000	-32%

Source: NHS National Services Scotland - National Energy Management System.

Major emitting sites

Building energy emissions are highly concentrated among a small number of large, energy intensive hospitals which are in continuous operation and house specialist facilities and complex medical equipment.

In the financial year 2024/25, the top 20 emitting sites (around 2% of NHS Scotland’s estate) produced around 245,000 tCO₂e, accounting for around 60% of NHS Scotland’s total building energy emissions. This imbalance highlights a clear opportunity: targeting energy efficiency and heat decarbonisation at top-emitting sites could deliver disproportionately large reductions in NHS Scotland’s overall carbon footprint.

Health boards are developing site specific decarbonisation plans for a selection of the most energy intensive acute hospital campuses, building on existing Board level plans or net zero route maps to deliver targeted and phased decarbonisation programmes. This selection includes the Queen Elizabeth University Hospital, Glasgow, and the hospitals at the Edinburgh Bioquarter (the Royal Infirmary of Edinburgh and the Royal Hospital for Children and Young People). Taken together, these two sites account for 13% of NHS Scotland’s heat and power emissions. Detailed planning will also begin soon for other sites, including Foresterhill, Aberdeen which as a large and complex site accounts for 9% of NHS heat and power emissions.

Heat networks are a fundamental element of the Scottish Government’s strategy for decarbonising heat in buildings. Large NHS sites can act as a catalyst for the development of local heat networks by providing an anchor load as they will often be the single largest heat user in an area. Health boards are working to make NHS sites ready to connect to heat networks including measures such as de-steaming existing heating systems.

Actions taken

A dynamic purchasing system for Corporate Power Purchase Agreements (PPAs) was launched by NHS National Procurement on 1 August 2025. Prior Information Notices (PINs) covering private wire PPAs have also been issued over the course of the last 12 months by NHS National Procurement to assess the ability of the market to supply renewable electricity directly to major NHS sites through private connections. Securing PPAs is a core part of the NHS decarbonisation strategy as they will result in increased supplies of renewable electricity and reduce the costs of electrified heat and transport.

Funding is being provided by the Scottish Government to allow health boards to reduce their energy consumption and bills, freeing up revenue funding for investment in clinical services. Over £10 million of capital funding has been allocated to date in 2025/26 to health boards for energy efficiency and heat and power decarbonisation measures. This includes the installation of LED lights and upgrades to Building Energy Management Systems and sub-metering.

Sustainable Transport

The Climate Change Committee recently outlined that emissions reduction from surface transport is the largest potential contributor to meeting the first two carbon budgets. In this sense, the electrification of transport is essential to decarbonisation efforts. There is also, however, a need for reduction in miles travelled to meet this target. As such, behaviour change is required to help bring about more active and sustainable travel to help the decarbonisation of transport.

The Scottish Government’s Renewed Policy Statement, which replaces the previous 2030 goal of reducing car kilometres by 20%, details the desire for commitment to, and necessity of, achieving car use reduction whilst improving active and sustainable travel access and provision. Active and sustainable travel is central to the NHSScotland climate emergency and sustainability strategy: 2022-26 and achieving net zero ambitions.

Fleet

Fleet decarbonisation continues to be progressed within NHS Scotland. As shown in table 3 below, as of April 2025, the percentage of zero tailpipe emission (EV) cars within NHS Scotland stood at 55%, Light Commercial Vehicles (LCVs) 35% and heavy vehicles (HVs) 1%. Over the last three years the percentage of EVs for all vehicle types, except motorbikes, has risen.

In 2025, NHS Orkney became the first Health Board to complete the electrification of its fleet and now has 32 electric cars and 5 electric vans. The progress made by NHS Ayrshire and Arran over the last three years is also worthy of note. In October 2022, NHS Ayrshire and Arran had 10 electric cars. This increased to 45 by March 2023. As of April 2025, the Health Board has 234 electric cars, making up 94% of its total car fleet. This is the fastest rate of increase across NHS Scotland and demonstrates that rapid change can be made under the right conditions.

Table 3: NHS Scotland Fleet Composition, April 2025

Class	EVs	Fossil Fuel & Hybrid	Total	% EVs
Cars	1258	1048	2306	55
Light Commercial Vehicles	479	885	1364	35
Heavy Vehicles	15	1089	1104	1
Motorbikes	0	10	10	0

Business Travel

NHS Scotland Assure has worked with the national payroll systems team in NHS National Services Scotland to create a bespoke business mileage report for all NHS boards. This has allowed for improved reporting and visibility of data for business travel by car.

Analysis of business mileage from 2023/24 showed:

• Business mileage claims accounted for £23 million spend in 2023/24 across all NHS boards.
• A total distance of 45 million miles in business mileage claims were made across all NHS boards.

Business travel by car created approximately 17,000 tonnes of carbon emissions across all NHS boards in 2023/24. In 2024/25, there were improvements across all categories, as follows:

• Business mileage claims accounted for £22 million spend across all NHS boards.
• A reduced total distance of 42 million miles in business mileage claims across all boards.

Approximately 13,000 tonnes of carbon emissions were created across all boards, a decrease of around 4,000 tonnes. The amount of this decrease is affected by fewer large engine cars being used as well as changes in fuel types.

It was not possible to determine accurate carbon emissions from the national eExpenses system for transport modes other than car and there continues to be a need for these to be assessed locally by each Health Board.

Effective and Sustainable Prescribing

Medication is the single most common healthcare intervention and generates the third highest cost of health expenditure. Polypharmacy occurs when an individual takes two or more medications. Regular medication reviews are recommended for polypharmacy. The appropriateness of polypharmacy should be considered at each initiation of new treatments, and when the person moves across different health care settings. Inappropriate polypharmacy can lead to poor health outcomes, unsustainable levels of expenditure and avoidable environmental damage.

The Scottish Government and NHS Scotland have recently produced a comprehensive update of the national Polypharmacy Guidance, developed with a multidisciplinary team across Scotland, with clinical and policy expertise from NHS Scotland and Scottish Government and with experts by lived experience. This is currently undergoing a full consultation process with final publication expected early 2026. The updated guide focuses on the care of adults with multiple medical conditions, applying the principles of value-based healthcare and realistic medicine. The guidance promotes a person-centred approach to care, the 7-Steps to Appropriate Prescribing and Polypharmacy.

A polypharmacy implementation toolkit was developed to support individual GP practices to identify and prioritise ideas for change and aid with implementation of polypharmacy reviews in practice. The toolkit guides practices through current guidance and evidence, a data pack to assist them in examining current regional prescribing trends and identifying priority areas for quality improvement, alongside a template that allows a standardised approach to 7-Step polypharmacy reviews. It promotes centred care, consideration of non-pharmacological interventions and provides links to useful resources from trusted sources for healthcare professionals and individuals. High priority areas identified include individuals:

• prescribed 10 or more medicines
• taking high risk medicines
• living with or at risk of frailty
• aged 50 years and over and resident in a care home
• approaching the end of their lives.

These resources are available to access through the Right Decision Service website or app.

Climate Emissions from Inhalers

CO₂ emissions (tCO₂e) in respiratory prescribing are driven by high global warming potential propellants in pMDIs.

Total annual inhaler emissions have reduced to 74,000 tCO₂e from a high of 90,000 tCO₂e in 2022/23. This change has been driven by a switch from inhalers with a higher volume of propellant gas to ones which deliver the same dosage of medicine using a lower volume of propellant.

Table 4: NHS Scotland pMDI inhalers emissions

Calendar Year	Classification	Total inhalers	Total tCO2e adjusted
2020/2021	pMDI	4,488,000	85,000
2021/2022	pMDI	4,657,000	87,000
2022/2023	pMDI	4,843,000	90,000
2023/2024	pMDI	4,890,000	84,000
2024/2025	pMDI	4,736,000	74,000

Around 70% of pMDI emissions are due to salbutamol inhalers. Clinical guidance published in November 2024 by the British Thoracic Society, National Institute for Health and Care Excellence and the Scottish Intercollegiate Guidelines Network removes salbutamol from mild and moderate asthma pathways, recommending the use of Anti-inflammatory Reliever (AIR) Therapy or Maintenance and Reliever Therapy (MART) to improve health outcomes for newly diagnosed or poorly controlled individuals with asthma. As implementation of this guidance progresses, a significant reduction in pMDI prescribing is expected resulting in a significant reduction in CO₂ emissions, as a co-benefit of improved treatment of asthma.

The introduction of next generation propellants from 2025/26 is welcomed, as this assists with person-centred care. The most appropriate inhaler choice should be made for the individual based on their ability to use it, with availability of sustainable choices being an important factor. Continued focus on person-centred respiratory reviews will ultimately improve not only respiratory care but sustainability in respiratory care.

Medical Gases

Medical gases are an essential part of any modern health service, but some are significant greenhouse gases and need to be managed appropriately. The Scottish Government and NHS Scotland are working together to reduce their climate impact.

Volatile anaesthetic gas emissions were slightly over 1,100 tCO₂e in 2024/25, down from over 10,000 tCO₂e in 2017/18. Most of the decrease is due to the reduction in the use of desflurane, a greenhouse gas with a very high global warming potential. The adoption of low flow anaesthetic techniques has also contributed to the decrease in emissions.

Nitrous oxide (N₂O) is an ozone depleting substance and a potent greenhouse gas with a 100-year global warming potential 265 times that of carbon dioxide. It is no longer used as extensively in modern anaesthetic practice. It was largely supplied through piped systems from central manifolds and much of its consumption was due to leakages rather than actual clinical use.

Good progress has been made in reducing anaesthetic N₂O emission through rationalising its supply. Emissions have fallen from 9,200 tCO₂e in 2018/19 to 3,700 tCO₂e in 2024/25.

Some health boards are still in the process of reviewing their anaesthetic N₂O supply and taking appropriate action and so further emissions reductions are expected. The anaesthetic nitrous oxide system loss mitigation and management document on reducing N₂O emissions is available here.

N₂O is also used for pain relief in combination with oxygen, under the brand name Entonox, commonly known as “gas and air”. It is an important source of pain relief, and particularly important for pain management in maternity services. As with N₂O used for anaesthesia, leaks from supply systems are a large source of waste.

Emissions from Entonox reached their lowest level in 2024/25 since 2018/19 – an 11% decrease over that period and 4% lower than the year before, 2023/24. However, it is still too early to conclude that this is a trend or that it is due to reductions in wastage.

Entonox is now the most important gas for action to reduce medical greenhouse gas emissions. Guidance has been published on how to reduce Entonox wastage.

Waste Reduction

Waste Management

Effective waste management is a vital part of NHS Scotland’s sustainability strategy. NHS Scotland generates over 21 waste streams, far exceeding the typical domestic and recycling categories familiar to the wider population. Managing this waste is a highly regulated and complex process involving clinical, pharmaceutical and radioactive materials. In November 2024, the Scottish Government issued DL (2024) 27, Waste Management Officer Responsibilities, Compliance and Financial Saving Opportunities, which reinforced the importance of the Waste Management Officer (WMO) role and the opportunities it brings.

Reducing Clinical Waste

In 2024/25 NHS Lothian piloted a waste reduction project in selected wards closely evaluating clinical waste. Feedback on this waste was shared and as a result, clinical teams agreed to change their waste management practice. This small trial achieved promising results, including projected annual savings of £5,400 and a reduction of 3.3 tonnes of CO₂ in just a small area.

NHS Borders held two waste-related events:

• an online sustainability conference with a focus on waste
• interactive waste management sessions with information and games to encourage the correct segregation of waste.

These events resulted in their recycling figures increasing by 4% and clinical waste decreasing by 9% in the first quarter of 2025 compared to the first quarter of 2024.

The clinical waste produced by each Health Board has been compared to their percentage share of total waste against funding allocations using the National Resources Allocation Committee (NRAC) formula and related percentages. It is acknowledged that NRAC is an imperfect comparator but is a consistent way to benchmark without the need to compare complex data sets relating to clinical episodes and activity.

The Scottish Government has included clinical waste reduction within its national financial improvement programme (15 box grid) in 2025/26 with NHS Scotland encouraged to reduce clinical waste weight by 30%. The graph below shows the percentage of clinical waste by board in 2023/24 compared with NRAC percentages.

Progress made towards waste reduction targets

Waste data continues to be problematic in many areas and is not always consistent. Reasons for this include an increase in estate size and changes to contracts and uplifts. Work is currently taking place at a UK-wide level to develop a mandatory digital waste tracking service^[3]. This system will replace paper-based records with a centralised digital platform that tracks waste from production to disposal. This is expected to significantly improve data reliability. Additional work on waste data is also being carried out within NHS Scotland to progress with a reporting system for NHS Scotland Boards and contractors, providing a central point of waste management data information.

Table 5: NHS greenhouse gas emissions from waste disposal, tCO₂e

Date	Reporting boards	Amount of tCO2e
2019/20	13	3,009
2020/21	14	3,333
2021/22	15	6,627
2022/23	15	7,656
2023/24	21	7,574

This is a change of +151.7% in the period 2019 to 2024.

National waste management campaigns

In 2024/25 NHS Scotland has continued to advance national waste management campaigns. In response to compliance concerns about clinical waste, campaign efforts have been initiated focussing on improving segregation of metals and batteries in clinical environments. Posters and guidance were made available to Health boards through the Sustainability Action Programme website in July 2025 to increase awareness and competence in this area.

Training

In February 2025, NHS Scotland Assure partnered with the NSS Sustainability Manager and NHS Education for Scotland to launch an updated 40-minute high-level waste management training module which is accessible to all staff. It covers key topics including waste segregation and the end-to-end journey of waste. To date 51,000 staff across health and social care have completed the module.

Webinars were delivered to over 500 dental team staff. A combination of in-person and online training sessions and visits were conducted across multiple NHS Boards. A training and quick-fire Q&A session by NHS Scotland Assure was recorded in September 2024, and this is accessible to all NHS Scotland Boards.

Waste Sustainability Projects

The Golden Jubilee National Hospital conducted a three-month recyclable paper towels trial, collecting 1,050 kg of product and achieving an estimated carbon saving of 454 kg CO₂. While the volume was relatively low due to the nature of the material and the small scale of the trial, this project serves as a valuable exemplar for future initiatives.

Circular Economy

Moving to a circular economy is a key element of Scotland’s sustainability and net zero policies, supporting not only environmental sustainability but also social and economic improvements. The circular economy has the potential to increase economic prosperity across Scotland through skilled job creation. Importantly, it also supports supply chain resilience, helping to reduce price increases caused by material scarcity, critical raw material concerns and access risks.

Introduction to Circular Economy

Circular economy describes models of production and consumption which maintain products and material quality as an active part of the economy. Circular models of supply often focus on innovation and offer new ways of procuring and accessing the goods and services we need.

Waste, inefficiencies and waste management represent costly losses in the system. Direct waste management costs are over £18 million per year with indirect costs of waste containers, vehicles and staff time adding to this significantly. Circular economy models, on the other hand, often rely on ‘product service loops’ which support re-use through return systems, extended responsibility and remanufacture, as shown in the diagram below.

The Scottish Government and NHS Scotland are working with UK regulatory and standards agencies with support from the UK ‘Design for Life’ programme. This programme focuses on increasing circularity in the medical technology sector and is co-ordinated by the UK Department of Health and Social Care (DHSC). Key drivers for ‘Design for Life’ are to increase efficiency and identify whole system financial savings by considering opportunities across the life cycle of products.

Reusable sterile gown trials were launched in 2024 and 2025 by NHS Lothian, NHS Lanarkshire, and NHS National Waiting Times Centre in partnership with NHS Scotland Assure and the National Green Theatre Programme. The trials aim to replace single-use gowns in clinical settings. Early results are promising, and a comprehensive report is expected in the coming months.

We are also working with a number of academic and industry partners on projects which include:

• REHEAL - a European funded project led by NHS Scotland and the University of Edinburgh, which focuses on data systems that will enable remanufacturing and material recovery from medical devices across Europe. It brings together a Buyers Group of five healthcare systems from the UK, Spain, Denmark, Greece, and Poland, representing 261 hospitals and over 17 million citizens
• The Digitally Enabled Circular Healthcare Innovation (DECHI) Research Programme - a collaboration between the Universities of Exeter, Sheffield, Cambridge and Manchester, working across the UK
• Design Hopes - a design-led research initiative, which also covers transport, collaboratively working between five Scottish Universities and NHS Scotland
• Partnering with the University of Edinburgh on research into the history and culture associated with single use plastics medical devices to better support efforts to change behaviours.

Memorandum of Understanding with Galicia

Following on from work in 2024, this year the Scottish Government signed a Memorandum of Understanding with the Government of Galicia to define and consolidate the cooperation of the participants on the promotion of net zero healthcare systems within the scope of their respective powers.

Galicia was identified as an exemplar international partner for their work on integrating circular economy in their regional healthcare system. The Galician Health Circular Economy Strategy (2020-2030) aims to shift the region's economy from a linear "take-make-dispose" model to a more sustainable, circular model focused on resource efficiency, waste reduction, and the reuse/recycling of materials. The Memorandum of Understanding can be found here. The non-binding memorandum aims to promote knowledge sharing and facilitate the development of innovative processes and products that increase sustainability, reduce waste and improve economic efficiency in healthcare systems in Galicia and Scotland.

Sustainable Design and Construction

The overall impact of the healthcare built environment on the net zero targets for NHS Scotland is significant. It is therefore critical that greenhouse gas emissions are reduced to as close to zero as possible within our estate. There is a challenge in realising that position whilst meeting all other requirements in such a complex built environment. As part of a process of continual review, research was undertaken to determine “what does good look like" with a specific focus on:

• reducing overall energy demand within differing areas of construction
• viable Zero Direct Emissions Heating solutions for the healthcare estate
• limiting the amount of embodied carbon in healthcare construction
• increasing circularity in healthcare construction.

This research has now informed an update of the Sustainable Design and Construction Guide (SDaC), which is available here.

This updated version builds on previous updates from the 2021 version and has been developed to:

• Streamline content and reduce signposting to other guidance and toolkits
• Clarify use across varying project scopes
• Provide clarity on requirements by simplifying the language and formatting of the document
• Support NHS Boards in setting targets for Whole Life Carbon (WLC) and Energy Use Intensity (EUI).

It details the process, actions and additional supporting standards required for health boards to follow and apply. By doing so, NHS boards will be able to evidence and deliver the performance outcomes needed to mitigate the health impacts of climate change and achieve sustainable quality in the present and future delivery of the healthcare built environment across Scotland.

The guidance is complemented by the SDaC Evaluation Toolkit. The toolkit is designed to provide a framework for health boards to ensure that they use all necessary methodologies and tools and understand good practice approaches to allow them to meet policy requirements that will deliver a robust, sustainable healthcare environment.

National Green Theatres Programme

The National Green Theatres Programme’s (NGTP) vision is to embed sustainability into every clinical and managerial decision across NHS Scotland. The work of the NGTP is implemented through Scotland’s 22 health boards, who must take credit for implementing or supporting the drive to reduce carbon emissions from theatres.

Carbon savings resulting from NGTP measures are reported by NHS Boards through relevant data reporting channels, such as energy, waste and water.

A table of released actions for implementation (Health Board to work with NGTP to validate and report on improvements) and published actions for adoption (not requiring measurement but provided to raise awareness of other changes that can contribute to reducing emissions) is shown below. The NGTP continues to work with clinicians, subject matter experts and national partners to assess, develop and implement actions to reduce the carbon emissions of operating theatres across NHS Scotland.

Table 6

Theme

Clinical practices

Released actions for implementation:

• Change peri-operative paracetamol from intravenous to oral
• Embed rubbing not scrubbing
• Reduce unnecessary use of non-sterile gloves

Published actions for adoption:

• Embed telephone and video clinics
• Self-removal of catheters

Reusable, remanufactured and reprocessed devices

Released actions for implementation:

• Introducing alternative to battery operated Pulse Lavages
• Introduce environmentally friendly fluid warming devices
• Embed lean surgical trays

Published actions for adoption:

• Introduce reusable plastic drugs and equipment trays
• Rationalising single use patient warming devices during the perioperative period

Volatile gases

Released actions for implementation:

• Decommission nitrous oxide manifolds
• Remove desflurane liquid

Waste

Released actions for implementation:

• Embed waste segregation
• Change to surgical fluid suction system that discharges into grey water system

Estates and facilities

Released actions for implementation:

• Switch off out of hours Heating Ventilation Air Conditioning (HVAC)
• Switch off out of hours anaesthetic gases scavenging systems

Published actions for adoption:

• Enable active travel
• Switch off non-productive devices

Supporting implementation of carbon saving actions

In February 2025, NGTP brought together colleagues from NHS Assure, Antimicrobial Resistance and Healthcare Associated Infection Scotland (ARHAI), and NHS National Services Scotland (NSS) for a national “Myth Busting” seminar on switching off Heating, Ventilation and Air Conditioning (HVAC) systems in operating theatres when not in use. This session tackled common misconceptions and featured a presentation from NHS Greater Glasgow and Clyde, who shared their real-world experience of implementing this approach. The event attracted over 100 participants from across Scotland.

Year ahead

The NGTP will continue to develop and implement actions to reduce the carbon emissions of operating theatres. It will consider how the programme can enable a shift across NHS Scotland away from single use to reusable alternatives for medical devices and textiles.

It will also consider how capacity can be released or created in the system to support the processing of reusable alternatives. NGTP will support implementation of the lean tray action helping clinicians and decontamination staff with the aim of reducing the number of instruments and sizes of tray sets. It will also scope out the potential for expansion into other clinical settings where there are opportunities to reduce emissions and waste.

Environmental Stewardship

Environmental Management Systems

The development of an Environmental Management System (EMS) is a key requirement under DL (2021) 38 and the NHS Scotland Climate Emergency and Sustainability Strategy (2022–2026).

In 2023/24, only 4 boards were in the planning phase of EMS development. By the end of 2024/25, 18 boards had begun development, each progressing at different stages using an ‘Agile’ approach.

An EMS is a structured system for managing environmental responsibilities, supporting goals like Net Zero through impact assessment, controls, processes and compliance.

ISO14001 is a global standard for developing an effective EMS, helping organisations improve resource efficiency, reduce waste, reduce pollution and demonstrate environmental responsibility and compliance. It follows the Plan-Do-Check-Act cycle and takes a whole-systems approach, considering internal and external factors.

Despite progress over the past two years, EMS implementation varies widely across health boards. EMS implementation depends on strong leadership, governance, collaboration from a cross-organisational cross-functional team and dedicated board level resources to coordinate its implementation. Boards with EMS-specific roles have advanced more quickly, while others struggle due to limited capacity. Dedicated resources are essential to drive development, manage the system, and ensure continuous improvement.

In 2023/24, a full set of ISO14001-compliant EMS templates was developed for NHS board use. In 2024/25, an Excel-based EMS Implementation Checklist Tool (EMS ICT) was launched. It guides NHS bords through four development and implementation stages with embedded templates, clause explanations, and audit evidence checklists.

Climate Change Career Guide

In 2024/25, NHS Scotland launched the Climate Change Career Guide to highlight climate focused roles across health boards. It helps staff explore green career paths, access training and engage in local health board climate action. The guide supports both new and experienced professionals, offering learning options from accredited courses to on-the-job training. It also promotes networking through sustainability groups and national green skills initiatives. NHS Education for Scotland plans to publish it externally to attract climate conscious candidates. Further promotion is planned for 2025/26.

Sustainable Development Impact Assessment Toolkit

In 2024/25, NHS Scotland Assure developed a Sustainable Development Impact Assessment Toolkit to help health boards assess the social, environmental, and financial impacts of their activities. The excel-based tool, with automated reports and guides, supports informed and sustainable decision making by identifying potential trade-offs and co-benefits. Usable by individuals or teams, it encourages inclusive assessments involving internal and external stakeholders. The toolkit will be officially launched and promoted in 2025/26, with a Learning Network Event planned to demonstrate its use.

NHS Scotland all staff Environmental Sustainability eLearning Course

In 2023/24, an all-staff eLearning course on environmental sustainability was developed with input from 10 health boards and tested across 12. The 35-minute course, available on turas Learn and LearnPro, introduces key sustainability concepts and actions for staff and NHS Scotland. In 2025/26, further promotion of the module is planned.

Sustainable Procurement

NHS Scotland Procurement Strategy Launch

NHS Scotland has launched its Procurement Strategy (2024-2028), outlining a collaborative, sector-wide vision for procurement services across NHS Scotland. This strategy has been developed in collaboration with NHS Boards. It successfully aligns with the strategic objectives of NHS Scotland and the procurement plans of individual boards. Making the best use of NHS Scotland’s spending power is a key focus of this strategy that draws from the Public Procurement Strategy for Scotland. This launched in April 2023 with a vision of ‘putting public procurement at the heart of a sustainable economy’ to maximise value for the people of Scotland.

Strategic Priority Framework

This framework is mapped and linked to the Public Procurement Strategy for Scotland and its four outcomes: Good for society, Good for businesses and their employees, Good for places and communities, and Open and connected.

The Framework consists of six strategic priorities. These are:

• Developing workforce capabilities and skills
• Collaborative procurement
• Embedding sustainable and ethical procurement
• Developing supplier relationships, maximising value and reducing risks
• Ensuring contract and supply chain security and resilience
• Procurement technologies: digitisation and technology roadmap.

These are underpinned by three enabling strategic capabilities:

• Governance and regulated government compliance
• Reporting capabilities and protocols to enable single system reporting and analytics
• Continuous improvement.

Next year, National Procurement will focus on driving adoption of the new NHS Scotland Procurement Strategy. Our Best Practice Group will develop an improvement plan to integrate strategic priorities into the Procurement and Commercial Improvement Programme.

Climate Change

In early 2025, a commodity specific strategy was developed with the aim of adopting a structured approach to the consideration of relevant risks (environmental and social) and opportunities, whilst being relevant and proportionate to the products and services being procured. All national tenders within the NHS go through the procurement journey process where all aspects of sustainability are considered during the development of the strategic approach.

Depending on the outcome of this formal review, additional and more detailed assurance supported by evidence may be requested as part of the supplier submission process including independent audits, evidence of compliance to all relevant legislation and the removal of all potential slavery links.

Ethical Trading and Modern Slavery

The global glove supply market is closely monitored for ethical trading and labour standards compliance. For our medical examination glove procurement which took place this year, we required all tendering suppliers to provide assurance regarding compliance to these standards and all necessary legislation and industry best practice. A Supply Chain Integrity Policy was implemented, managed by the supplier’s legal compliance team. This process requires all third-party glove manufacturers to undergo a risk assessment based on their nature, materiality, location, product classification and ownership.

Supplier Sustainability Dashboard

National Procurement request Carbon Reduction Plans for all relevant and priority tenders in line with mandated requirements in the Scottish Procurement Policy Note 3/2022. Development of a reporting suite continues with our supplier sustainability dashboard. National Procurement has captured a net zero plan for all our strategic suppliers and 30% of our total contract supplier base with a target to capture over 90% of our contract suppliers in this financial year. We will continue to monitor supplier plans and ensure increased compliance with the 2040 net zero target.

Decarbonisation and Renewable Energy

To support NHS Scotland to become net zero by 2040 and achieve a 70% reduction in our carbon footprint by 2030, we have developed our Decarbonisation and Renewable Energy category team. The core function of this team is to assist health boards in the successful conclusion of Heat and Power Purchase Agreements with the aim of reducing energy costs and carbon emissions.

Social Outcomes

The Procurement Reform (Scotland) Act 2014 sets out the requirements for public procurers in Scotland to achieve the Scottish Government aims to make the best use of public money and assist the government to achieve its overarching purpose and strategic objectives. For any contract (including frameworks) over £4 million, consideration is given as to whether to include a community benefit clause. Increasing community benefit has been a key focus area this year as well as further increasing the scope to help improve the economic, social, and environmental wellbeing and assist in the reduction of health inequalities across Scotland. A further measure was introduced to deliver social value in 90% of all procurement contracts worth over £1 million.

Community Benefits

Our work continues in collaboration with Public Health Scotland to improve the economic, social, and environmental wellbeing of local areas through the Community Benefits Gateway Portal. The portal is a free and easy to use online service connecting NHS Scotland suppliers with third sector community organisations in Scotland who are looking for assistance with a variety of needs. This year the community benefits process has been further developed and embedded with the number of suppliers registered on the portal increasing from 510 to 753 and an increase in community benefits secured from 43 to 68.