NHS Scotland climate emergency and sustainability strategy: 2022-2026

This document sets out plans for NHS Scotland to reduce its greenhouse gas emissions and impact on the environment, adapt to climate change and to better contribute to the United Nation sustainable development goals. It has been developed by the Scottish Government and NHS Scotland Assure.

Our approach to Net-Zero

27. We aim for NHS Scotland to become a net-zero organisation by 2040 or earlier for the following sources of NHS emissions:

  • building fossil-fuel 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

28. We also aim to maximise our contribution to Scotland and our 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

29. Our approach to net-zero is not based on carbon off-setting. The UK's independent, statutory Climate Change Committee advises that most sectors will need to reduce emissions close to zero without offsetting. We are, therefore, working to bring our emissions as close as possible to zero as early as we can. The UK Government forecasts that the electricity grid will produce 15 gCO2e for every kWH produced in 2040, falling to 7g by 2048.[10] NHS Scotland's activities will still result in some residual emissions by that point and some form of off-setting will be required. But our pressing task now is to rapidly reduce our emissions as much as possible and how to off-set residual emissions is for a later date.

The NHS Scotland Carbon footprint

30. Our knowledge of the NHS Scotland carbon footprint is still developing. We have excellent data for some emissions sources but little or inaccurate data for others. The following table sets out known NHS Scotland emissions for 2020/21:

Table 1: Known NHS Scotland emissions, 2020/21
Source tCO2e
Building energy use 431,000
Metered dose inhaler propellant (fluorinated gases) 79,000
NHS Fleet 60,000 (data incomplete)
Anaesthetic gases 27,000
Waste 6,900 (data incomplete)
Waste water treatment 3,200
Water consumption 1,600
Total 608,700

31. We recognise that there are gaps in the data for our 2040 targets and we have started work to improve the quality and comprehensiveness of that data. There is a lack of consistency in the information that Health Boards provide in their statutory annual climate change reports and three Health Boards are not currently required to provide them. Starting in 2022, all Health Boards bodies will report on their greenhouse gas emissions which are subject to the 2040 target.

32. Two of the major gaps we have in accurately setting out the NHS's carbon footprint is the supply chain and staff, patient and visitor travel. NHS England has estimated that its supply chain makes up 62% of its total carbon footprint using a spend-based method.[11] There are limitations to spend-based methods for calculating emissions and they are very much a broad-brush approach. However, it is undoubtedly the case that the supply chain is a very large source of emissions and is most likely the largest single element in the NHS carbon footprint. Our plans to improve our understanding of supply chain emissions are set out in the chapter on Sustainable Goods and Services.

33. There are also challenges with assessing the emissions resulting from staff, patients and visitors travelling to and from NHS services and facilities. What we do know is that domestic transport is the sector which produces the most greenhouse gas emissions in Scotland (29% of the total for 2019[12]) and that car travel is the mode of travel which produces the most emissions (38% of Scotland's transport emissions).[13] Our plans to improve our understanding of how staff, patients and visitors travel to NHS sites are set out in the chapter on Sustainable Travel.

34. Further data on NHS Scotland's carbon footprint and environmental impacts is set out in Annex B.


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