Health Secretary Humza Yousaf has launched NHS Scotland’s Climate Emergency and Sustainability Strategy, seeking to reducing emissions, adapt to climate change, and better contribute to the UN’s Sustainable Development Goals (SDGs). The Royal Pharmaceutical Society Scotland has already supported the strategy, saying it strongly aligns with their sustainability policies.

Health Secretary, Humza Yousaf said he was pleased to announce the publication of the national strategy during a visit to Scotland’s first low-carbon hospital:

“Our approach will help us to build on the great work which has already been done to accelerate our efforts to cut greenhouse gas emissions and become environmentally sustainable.

“As well as the environmental impacts, I am also very mindful of the recent increase in energy prices, and there is a clear benefit in reducing energy use and increasing efficiency in everything we do. To achieve the transformational change that is necessary we need to establish a culture where resources are safeguarded and used responsibly.”

Outlining the approach and actions to be taken by NHS Scotland health boards, the strategy builds on earlier policy proposals in Scottish government. Supported by the government and other partners, NHS Scotland also aims to respond to the climate emergency in a wider sense, acknowledging its role in relation to UN SDGs.

To reduce its environmental impact across different areas of healthcare's carbon footprint, the strategy targets five crucial points of development. NHS Scotland is working on climate action across these major aspects of healthcare, from infrastructure and travel to goods and services, to care and in communities. 

The Royal Pharmaceutical Society (RPS) Scotland welcomed the publication as it “aligns firmly with RPS Scotland’s sustainability policies”, with medicines accounting for 25% of carbon emissions in the NHS.

Speaking about NHS Scotland’s sustainability strategy, Claire Morrison Director for RPS Scotland said:

“I am absolutely delighted to see NHS Scotland has taken on board our suggestions in the consultation for this strategy, and to read that improving the sustainability of medicines use features heavily.”

RPS Scotland says that as the professional leadership body for pharmacists, they have made sustainability a “top priority” and are committed to reducing the environmental impact of medicines. Recently, RPS Scotland have also called for widespread support for more sustainable prescribing practices across Scotland.

Health inequalities

NHS Scotland’s new strategy describes climate change and health inequalities as “inextricably linked” and asserts that tackling climate change must be done in a fair way to avoid worsening inequalities:

“The Scottish government is committed to a just transition away from a fossil-fuel based economy. This means making the journey towards a net zero and climate resilient economy in a way that delivers fairness and addresses inequality and poverty.”

Aligning with the UN’s SDGs, the strategy also states that NHS Scotland will create opportunities to expand resources efficiently and develop sustainable approaches which help address inequality and poverty.

For example, health boards will support local NHS food growing sites and energy efficiency projects to help reduce fuel poverty.

Implementing the strategy will be supported by the Care and Wellbeing Portfolio taking a broad role interacting across government departments in policy reform and delivery to address health inequalities, create a sustainable healthcare system, and improve population health.

In 2021, the Director for Health Finance and Governance, Richard McCallum issued a letter on the ‘Policy for NHS Scotland on the Global Climate Emergency and Sustainable Development’ to health boards.

Mr McCallum explained the importance of responding to the crucial matter, confirming that climate emergency is “one of the Scottish government’s highest priorities”, and said the policy is mandatory for all NHS Scotland bodies.

Consultation on the draft strategy closed on the 10^th of March 2022, and yesterday’s publication outlines actions to take in support of the wider aims and targets of the policy outlined in 2021. One such aim for NHS Scotland is to be a net zero health service by 2040 “at the latest” in terms of its greenhouse gas emissions.

What is a ‘net zero’ NHS?

For NHS Scotland, it aims to reduce all sources of NHS emissions from buildings, travel, procedural gases, and energy and water usage by 2040 or earlier.

The strategy is clear that NHS Scotland will not take a “carbon off-setting” approach, instead working towards reducing current and future emissions “as close as possibly to zero as early as possibly” across all health boards.

In describing the ambition and approach of this strategy, the publication refers to Professor Joanna Haigh’s report on an integrated approach to climate change and human health, saying:

“Climate change poses a catastrophic threat to humanity and the natural systems that underpin our lives. It is obvious that tackling climate change will have a positive impact on human health.”

NHS Scotland also focuses on the large role that PPE supplies play in healthcare’s carbon footprint, with around £2.5bn spent annually on goods and services from 8000 suppliers.

Prioritising products designed for durability, repairs, and upgrades and then “recycled at the end of their useful life” is one way NHS Scotland is working to create sustainable procurement practices.

To this end, the strategy focuses on addressing the issues of products with high environmental cost and risks of unsustainable practices by working with suppliers. Over 1.07bn items of PPE were issued to the NHS and care homes from March 2020 to May 2021 and it is estimated that 90% of the energy from washing is from heating water.

Developments in materials for sustainable gloves and technology for healthcare uniforms to be washed on lower temperatures and have in-built virucidal properties present promising solutions from industry.

In the foreword, Mr Yousaf says climate change is the greatest threat to human health and highlights that environmental action benefits health when delivered effectively. Recalling the impacts of extreme heat, Mr Yousaf says “unprecedented change” is needed, adding that “good care is environmentally sustainable care”.

Although the strategy covers 2022-2026 and sets longer-term targets, the importance of urgency is not understated, with a commitment to publish overarching annual progress reports from 2023 onwards.

Health boards also prepare annual reports under the Climate Change (Scotland) Act and – from November 2022 on – each must publish its report, summarising progress in line with the actions defined within this strategy.

NHS Scotland says that the pandemic has shown it can act quickly in a crisis and urgent action is also required to address the climate emergency.

Launching the strategy at the “fully electric” Balfour Hospital, Orkney, which has air-to-water heat pumps and solar panels reducing reliance on the grid, shows how sustainable planning and practices can be built into healthcare.

Read more: Disposable gloves to protect patients and the planet; How air pollution affects our health; The case for virus-killing uniforms; Water Safety Scotland calls for caution amid heatwave

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