Fiona Schaefer, innovation manager at InnoScot Health, considers the Scottish NHS carbon net zero challenge, looking at what the sector has achieved and what it needs to focus on moving forward

With the NHS continuing to strive to meet net zero carbon ambitions in coming years, never has there been greater focus on identifying and integrating greener alternatives.

With activity aimed at meeting NHS Scotland’s 2040 net zero emissions target gathering pace, we have seen tremendous progress made across the country’s healthcare facilities through robust innovation-driven strategies, including the launch of its National Green Theatres Programme.

We also believe that NHS Scotland is now poised to make major strides across 2025 in that vital drive, which is not only reducing health service impact on the environment and generating cost savings, but also – and most importantly – helping to enhance the wellbeing of the very people it is treating.

It is now firmly recognised that climate change exacerbates existing health risks while posing new challenges which impact the health of the population, healthcare assets, and services.

As Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, put it: “The most-pressing reasons for urgent climate action are the impacts, not in the future, but right now, on health.

“The climate crisis is a health crisis.”

The Scottish Government agrees, stating that ‘NHS Scotland plays a pivotal role in safeguarding the life and health of communities by developing climate-resilient health systems capable of responding to these evolving threats’.

Reducing the impact

In achieving net zero, the greatest challenge is reducing building energy emissions, resulting chiefly from heating, lighting, and hospital activity.

The good news is that emissions from the energy used to heat and power NHS Scotland buildings continue to fall steadily – in some cases helped by purpose-built facilities.

Embodying the cutting-edge green vision, the new University Hospital Monklands in Lanarkshire is being built as a fully-digital and net zero carbon exemplar.

It is now firmly recognised that climate change exacerbates existing health risks while posing new challenges which impact the health of the population, healthcare assets, and services

Also falling steadily are medical gas emissions, including the replacement of anaesthetic gas Desflurane with a less-harmful gas, which is now saving emissions equivalent to powering 1,700 homes every year.

In fact, NHS Scotland won the European Sustainable Healthcare Project of the Year Award in 2023 after becoming the first national health service in the UK to stop using Desflurane with its high global warming potential and marked contribution to the carbon footprint of healthcare facilities.

In 2022/23, NHS Scotland’s reported emissions from its net zero target areas were 571,000 tonnes of carbon dioxide equivalent, of which 407,000 resulted from building energy use – a huge 70%.

A point of concern, yes, but also a clear picture of where significant effort needs to be concentrated.

Critical thinking

Last August, Scotland’s Cabinet Secretary for Health and Social Care, Neil Gray, also noted that a minority of 20 NHS sites were responsible for over 60% of building energy emissions with decarbonisation plans being prepared for those priority sites, a move rightly considered ‘critical to decarbonising the NHS’.

Gray cautioned that ‘some of these sites will be easier to decarbonise than others due to their age and construction’, but it is encouraging, nevertheless, to note that determined action is now either planned, or is underway, to continue the momentum behind a 31% reduction in NHS Scotland’s total heat and power emissions evidenced between 2015-16 and 2022-23.

In achieving net zero, the greatest challenge is reducing building energy emissions, resulting chiefly from heating, lighting, and hospital activity

Last year’s Annual NHS Scotland Climate Emergency & Sustainability Report echoed the Health Secretary’s sentiments, stating that: “For building energy, much more now needs to be done, but the achievements so far should make us hopeful in realising that further progress can be made.”

Indeed, the report found that NHS Scotland collectively met all of its annual energy targets relating to heating and powering buildings while its primary goals remain focused on:

• Reducing greenhouse gas emissions from NHS buildings by at least 75% by 2030 compared to a 1990 baseline
• Renewable heating systems being integrated into all NHS-owned buildings by 2038
• Net zero emissions being achieved by 2040 or earlier for all of its estate

In order to achieve those goals, the Scottish Government has urged that the country’s health boards ‘must find innovative solutions to reduce their energy emissions’.

To that end, significant sustainable opportunities include the potential for replacement of more-traditional energy forms with biomass boilers, solar panels, air source and ground source heat pumps, and battery storage.

We believe that innovation targeted at lowering buildings emissions identified by the knowledgeable, insightful Scottish health service workforce can be a huge asset in achieving that desired progress – and there are many opportunities for forward thinkers.

Certainly, staff can play a vital role in decarbonising NHS buildings by identifying, not only lesser-used areas which could benefit from the integration of smart technologies to monitor and respond to usage patterns, but also noting where improved building insulation and upgraded glazing could be most effective, thereby producing marked efficiency savings.

Only recently, staff at NHS Forth Valley revealed their work to optimise building energy usage within high carbon theatre facilities, including adjusting the speed of Heating, Ventilation, and Air Conditioning (HVAC) systems equipped with fans and evaluating the effectiveness of anaesthetic gas scavenging systems while maintaining safe and efficient working conditions.

Innovation

Sometimes external innovation can be just as effective as internal innovation.

Considering the natural environment around NHS sites, with staff-led initiatives helping to maintain and improve their biodiversity, are also enhancing wellbeing opportunities for both staff and patients.

Hand in hand with that is the continued rollout of eHealth and digital technologies to reduce travel, together with decarbonising fleet vehicles, making NHS sites truly greener places.

NHS teams are also undoubtedly best placed to offer everyday insights into how to manage building waste more effectively and encourage circular economy principles such as motivating patients to return used inhalers and introducing best practice on their wards.

Ultimately, they can be ambassadors for change, pushing for fellow workforce innovators to share ideas, while raising awareness and supporting sustainable action.

And InnoScot Health has a sustainability innovation call seeking forward-thinking ideas from health and social care professionals that can help support NHS Scotland in its green ambitions moving forward.