Executive Chair of InnoScot Health, Graham Watson, analyses the NHS Scotland estate

With NHS Scotland pushing hard to hit its target of net zero emissions by 2040 — including a 75% reduction in building emissions by 2030 – the drive to decarbonise a very diverse estate is firmly on.

In 2023, the Scottish health service became the first in the world to completely ban the routine operating theatre use of desflurane, an anaesthetic gas which has a global warming potential 2,500 times greater than carbon dioxide.

The Scottish Government stated that removing it from use in hospital theatres across NHS Scotland and shifting to safer alternatives would save emissions equivalent to powering 1,700 homes every year.

It was the first move of the newly inaugurated National Green Theatres Programme — and a significant step towards delivering the country’s pledge for carbon-neutral facilities.

Among the biggest decarbonisation projects happening across Scotland currently is St John’s Hospital in Livingston which is using Scottish Government funding to install a solar photovoltaic (PV) array, pipework insulation, LED lighting, and Building Management System (BMS) to centralise the control of heating, ventilation, air conditioning, and lighting, in turn significantly lowering energy waste.

It is thought that this will collectively make emissions savings of equivalent to the annual energy use of about 100 average residential homes.

This is just one example noted from right across Scotland’s health boards, collectively amounting so far to a capital investment in estate decarbonisation of almost £17.7 million since 2020-21.

It is clear that this ongoing focus on estate upgrades for improved energy efficiency is generating value with thousands of tonnes of carbon emissions being cut on an annual basis, as well as major cost savings.

Indeed, in December last year, the Scottish Government announced that NHS Scotland’s overall emissions had decreased by 32% since 2015/16.

However, while there are wide opportunities being tapped into with considerable reductions already realised, there also remain significant challenges to overcome.

Key hurdles include retrofitting NHS Scotland’s older buildings and managing the high costs that come with managing a varied portfolio ranging from hard-to-heat Victorian structures to ageing concrete towers that trap high levels of embodied carbon. Such estate diversity means that attempting uniform upgrades is complex.

Aside from these structural challenges, Scotland’s intensive care units (ICUs), operating theatres, emergency departments, and renal dialysis units are widely recognised as the most challenging clinical areas for the NHS to decarbonise.

There are of course intrinsic issues within these areas which are reflected worldwide — from the consistent need for operations, to the energy-intensive nature of life support facilities, and the requirement to meet clinical safety regulations which sometimes simply do not align with decarbonisation strategies.

Nevertheless, that is not to say that solutions cannot be identified through innovative approaches and expert multidisciplinary support.

Part of the challenge in these specialised areas then is helping to optimise clinical care pathways with efficient preventative measures, often underpinned by better planning with patients.

In other words, aiming to decarbonise through proactive strategies which can lead to a reduction in unnecessary interventions and, where possible, integrating greener equipment such as reusable plastics, and more durable PPE which can be washed at lower temperatures to save energy.

In the particular case of renal dialysis units, measures can include reducing dialysate flow rates where it is considered clinically safe to lower water and power use.

There are undoubtedly wider opportunities too with common adoption touchpoints for Scottish health boards being retrofitting insulation, high-efficiency double glazing, air source heat pumps, LED lighting, solar arrays, and heat recovery systems in efforts to produce significant annual carbon savings while overhauling aging, inefficient infrastructure.

Resource-permitting, smart building technology may hold the greatest long-term promise for NHS Scotland with the ability to leverage AI-driven sensors which respond to conditions and occupancy in real-time and optimise heating, cooling, and ventilation; which highlight inefficiencies in energy use and detect performance deviations; and can identify maintenance needs before issues occur.

It is clear that Scottish healthcare must adapt and become more agile in its response to decarbonisation priorities if it is to hit its 2040 target, and such innovation allowing NHS buildings to learn from their own data, is one vital direction of travel.