NHS Scotland - climate emergency and sustainability: annual report 2025

Part 2 - Climate Change Adaptation And Greenspace

Climate Change Adaptation

Climate change and NHS Scotland: Setting the Scene

Scotland is already experiencing the impacts of climate change with increasing temperatures, shifting rainfall patterns and more frequent and severe extreme weather events such as flooding, storms and heatwaves. According to the UK Climate Projections, Scotland is expected to see average temperature increases of up to 2°C by 2050, with summer temperatures from May to November potentially increasing by as much as 4°C^[4]. These changes present serious threats to public health and the healthcare system in Scotland.

In response to these growing threats, the Scottish Government has published the third Scottish National Adaptation Plan (SNAP3, 2024-2029), which outlines a coordinated, cross-sectoral approach to building resilience across public services. For NHS Scotland, this includes developing Climate Change Risk Assessments, estate level adaptation planning in line with the ISO 14090 principles and requirements, and action on flood vulnerability, overheating and other climate hazards^[5].

The potential impacts of climate change underline the importance of adapting our health system. NHS Scotland must strengthen its resilience to a broad range of climate related risks that are already 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.

NHS Scotland Climate Change Risk Assessments and Adaptation Plans for Healthcare Assets

To address these challenges, health 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 health boards have completed their CCRAs, and 18 have developed Adaptation Plans.

CCRAs

Health boards assessed a variety of climate hazards, including higher average temperature, extended periods of hot weather, extended periods of dry weather and drought, heavy downpours and driving rain, storm surge, coastal inundation and erosion, flooding, cold spells and combined climatic effects (including storms, high winds, lightning, fog, mist and low cloud).

Health boards face varying climate related risks with common challenges including transport and site access disruptions, supply chain interruptions, infrastructure and equipment damage, increased patient demand and compromised emergency systems. Some of these potential impacts are:

Table 1: Potential climate change impacts on healthcare assets and services

Nature of Potential Impact:

Transportation and site access

• Potential Impacts: Access routes closures

Transportation and site access

• Potential Impacts: Vehicles risk damage

Transportation and site access

• Potential Impacts: Cancellation of healthcare services

Essential supplies

• Potential Impacts: Supply chain disruptions

Essential supplies

• Potential Impacts: Water supply disruptions

Essential supplies

• Potential Impacts: Power outages

Building components and equipment

• Potential Impacts: Damage to critical building systems

Building components and equipment

• Potential Impacts: Damage to critical equipment

Building components and equipment

• Potential Impacts: Compromise backup power and generators

Building components and equipment

• Potential Impacts: Building refurbishment

Increasing number of patients

• Potential Impacts: Impacts on physical and mental health

Increasing number of patients

• Potential Impacts: Delayed patient discharge

Structural

• Potential Impacts: Building foundations damage

Structural

• Potential Impacts: Superficial structural damage

Emergency systems

• Potential Impacts: Increased strain on emergency services

Emergency systems

• Potential Impacts: IT and communication performance impact

Emergency systems

• Potential Impacts: Emergency services overloaded

Decreased staff wellbeing

• Potential Impacts: Increased stress and staff fatigue

Decreased staff wellbeing

• Potential Impacts: Loss of efficiency

After identifying the potential impacts per climate hazard, each health board assigned probability and consequence scores to determine the risk exposure for each impact. These scores were based on health board specific criteria, considering the likelihood of the impact occurring and the severity of its potential consequences.

The climate change potential impacts on NHS Scotland that have the highest risk exposure scores, and thus require urgent attention, are related to emergency systems, increasing number of patients and building components and equipment.

An overall analysis of the average risk exposure scores show that flooding is the hazard that has the highest risk, followed by combined climatic effects and heavy downpours and driving rain (see Table 2).

Table 2: Climate Hazard and Average Risk Exposure Score in all NHS boards

Adaptation Plans

Health boards Adaptation Plans include high-level adaptation measures involving a wide variety of actions from weather monitoring and temperature management to the implementation of nature-based solutions.

Some examples of proposed adaptation measures in their adaptation plans include:

• Establish alternative routes and rapid mass re-routing for ambulances and essential vehicles
• Installation of temperature monitoring equipment and/or enhance sensitivity of internal sensors
• Integrate Sustainable Drainage Systems into greenspaces and projects, enhancing water management, reducing flood risks and promoting environmental sustainability
• Establish a register for documenting experiences and lessons learned from adverse weather events
• Enhance data monitoring and management to identify energy consumption peaks and manage them, reducing overall demand during critical events
• Explore the possibility of implementing on-site water saving projects for avoiding water supply disruptions
• Co-ordinate with institutions (police, local authorities, community transport associations) to help in the transfer of patients and staff
• Enhance heat health education among staff. This includes disseminating information on outdoor work practices, staying hydrated, appropriate attire self-care during hot weather and understanding temperature differences within key buildings.

More information about the NHS Boards CCRAs and Adaptation Plans can be found in the NHSScotland Climate Change Risk Assessments and Adaptation Plans Summary Report.

Building Climate Resilience in NHS Scotland: The Road Ahead

Health boards CCRAs and Adaptation Plans mark a significant step forward in identifying the potential climate change impacts on healthcare assets and services. As we look ahead, it is essential that this momentum is maintained and scaled.

The next phase should focus on embedding adaptation across all levels of NHS governance and operations supported by consistent monitoring, data gathering and sharing and collaboration with local authorities and other key stakeholders. The implementation of adaptation plans will require sustained leadership, investment, and innovation to ensure NHS Scotland remains responsive, resilient and capable of delivering equitable care in an increasingly uncertain climate future. Strengthening organisational learning and integrating adaptation into routine planning will not only safeguard services and vulnerable populations but also contribute to a healthier, more climate resilient NHS Scotland.

Greenspace and Biodiversity

Greenspace and Biodiversity

Scotland is facing a biodiversity crisis, driven by factors such as land use change, habitat destruction, pollution and intensive agricultural practices. Our land use has led to unprecedented rates of habitat degradation and species loss, threatening the ecological integrity of natural systems and the services they provide.

In this context, NHS Scotland has a responsibility to manage its estate in ways that contribute to national biodiversity targets while also delivering a wide range of co-benefits. Strategic action on climate and biodiversity can transform greenspaces into multifunctional assets that support community growing initiatives, promote active travel by integrating green corridors and pathways, enhance therapeutic environments that support mental and physical health and improve air quality. These spaces can also play a critical role in increasing resilience to climate impacts.

Greenspace

An interim assessment of NHS Scotland greenspace was published in October 2024 by Public Health Scotland^[6]. The key findings from the report were:

• The size of the NHS estate in Scotland was 1,572 hectares - almost the size of the city of Stirling.
• It was estimated that just over half of the total NHS Scotland estate was greenspace - almost twice the size of Loch Lomond Nature Reserve (430 hectares).
• More than 50% of NHS Scotland greenspace was located within just four territorial health boards:
• NHS Greater Glasgow and Clyde
• NHS Lothian
• NHS Tayside
• NHS Fife
• Seven health boards had greenspace coverage exceeding 50% of their total estate:
• NHS Greater Glasgow and Clyde,
• NHS Tayside
• NHS Ayrshire & Arran
• NHS Dumfries & Galloway
• The State Hospitals Board for Scotland
• NHS Forth Valley
• NHS Fife.
• Only four health boards had greenspace cover of less than a third of their total estate. Even for the two boards with the lowest percentage of greenspace, NHS Shetland and NHS 24, it still comprised, in both cases, 28% of their respective estates.

Grassland Management

The Grassland Management Report was published in February 2024 to guide sustainable grassland practices at health board level. It encourages and demonstrates best practices in grassland management in healthcare environments and enables health board colleagues to champion the better use of grassland locally.

Several health boards participated in No Mow May with the intention of transforming the management of their grassland to benefit nature and reduce the costs of traditional practices. They continue to do so, with No Mow May now embedded in yearly sustainability and communications activities.

UK Habitats (UKHab) Survey

NatureScot funded a pilot initiative to map habitats on NHS Scotland estates with mapping work completed for NHS Greater Glasgow & Clyde, NHS Tayside and NHS Highland. Findings informed national assessments and local biodiversity planning both on the NHS estate and beyond.

The UKHab mapping work will be extended to cover all boards with greenspaces greater than 0.2 hectares in 2025/2026 and will be a powerful tool to support management of the NHS estate for nature.

Natural Capital Assessment

To build a better picture of the natural capital of the NHS estate from a health perspective, a national survey was undertaken by the University of Aberdeen to assess public use and value. The findings of this work were published in July 2025^[7]. This study looked at the value of outdoor green spaces within hospitals, health centres and GP surgeries used by staff, patients and their families and the public for walking and relaxing. The survey of 2,449 adults across all 14 regional health boards found that people spend roughly 87 million hours a year in NHS outdoor spaces. The health benefits from these visits are valued at around £82 million a year which is what it would cost the NHS to provide the same benefits through healthcare services.

In conjunction with the UKHab survey, individual natural capital assessments will be undertaken for NHS Boards to help further convey the economic and environmental benefits of the natural environment, with individual and NHS Scotland-wide reports being prepared.

Green health

Evaluation of the four pilot green health partnerships in Dundee, Highland, Lanarkshire and North Ayrshire was undertaken with reports published by NatureScot and the PHIRST Connect Research Team from the University of Hertfordshire confirming the effectiveness of these cross-sector partnerships in effectively and efficiently linking relatively low cost nature-based activity to people across a wide spectrum of health needs. These findings mirror the growing evidence from across the UK and internationally that green health can support conventional health approaches while also enhancing community cohesion, well-being and action on climate and biodiversity goals. The well-established green health week in May each year now provides the opportunity for all health boards to link into and promote this work.

To build on these partnerships, in January 2025, the Green Health Learning Network was launched by Public Health Scotland, with support from NatureScot and Greenspace Scotland. This network shares knowledge and learning across the green health agenda – from nature prescriptions to wider access to greenspace and the links between nature, public health and climate. Workshops were also held in August and September 2025 to discuss and develop a stronger framework for advancing green health which will be published early in 2026.