As part of launching its new Climate Emergency and Sustainability Strategy, NHS Grampian is making a public commitment to decommission all its nitrous oxide pipelines before the end of this year. 

Nitrous oxide is one of several anaesthetic gases used by health providers around the world and, although its use has decreased significantly in recent years, this work is still estimated to save the equivalent of up to 1274 tonnes of carbon dioxide on an annual basis across Grampian. This would be the same as driving around 7,300,000 miles in a small petrol car, and it would take around 63,000 trees – or a forest the size of 39 football pitches – a year to absorb.

A potent greenhouse gas, nitrous oxide remains stable in the atmosphere for up to 120 years and has a global warming potential 298 times greater than that of carbon dioxide. Over the past four decades globally its use and associated release into the atmosphere has increased exponentially, resulting in it now representing one of the largest impacts as an ozone depleting substance.

Rather than making the gas unavailable, NHS Grampian is switching to the use of smaller cylinder storage within operating departments, when using nitrous oxide is essential.

Consultant anaesthetist, Dr Calum McDonald, who is also training program director for anaesthesia across the north of Scotland, explained: “In Grampian, we have set up a Green Theatre Group, focused on the aims set out in the Centre for Sustainable Delivery's National Green Theatre Programme which is a hugely important part of our new NHS Grampian Climate Change and Sustainability Strategy. We are aiming to have decommissioned all of our nitrous oxide pipelines by the end of this year, and use cylinders instead where required, therefore reducing wastage from pipelines and associated storage leaks.

“Nitrous oxide is typically supplied through a piped system within NHS acute sites in Scotland, and it is estimated that between 83% and 100% of piped nitrous oxide is lost before it reaches the patient.

"We also have a working group looking in more detail at the use of Entonox (a mixture of nitrous oxide and oxygen) and I’d like to make it clear that it is and will continue to be offered routinely during labour. It is important to balance the clinical benefits of these useful means of pain relief with their long-term impacts, by exploring alternatives and finding new ways to make them both accessible and sustainable."

Work to make this possible follows other successes in making theatres greener in Grampian, including stopping the use of another harmful anaesthetic gas and saving all non-clinical waste which can be recycled from landfill.

Calum adds: “We can and we are making a difference to the environment, and we’re saving the NHS money at the same time. Thank you to everyone who is involved and doing their bit.”

In addition to developing more sustainable practices in theatres, NHS Grampian’s new strategy spans four key areas of activity. This will affect every area of the health board’s work, from delivering infrastructure to achieve net zero emissions, engaging employees in the contributions they can make to saving carbon and promoting more sustainable approaches to wellbeing, health and care.

Jillian Evans, Head of Health Intelligence and Learning Health Systems, who has played a lead role in the development of the strategy commented: “We’re really excited about involving staff and partners in a whole range of work, from restoring and improving green spaces within our estate, to engaging in community planning with partners and communities to promote human and planetary health. This will help us to prevent the types of health inequalities that are likely to determine our future health.”

NHS Grampian Board Chair, Alison Evison added: "Across NHS Grampian, we are committed to using innovation and quality improvement to identify more sustainable approaches to practice and to make more effective use of our resources, including our outdoor spaces. It will not be an easy task to significantly reduce emissions over the next few years but if we take action collectively to reduce waste and find new ways of doing things then I am confident we will make good progress."

Read the strategy in full (pdf).

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References for comparisons used in this article include:

• What is 1 Ton of Carbon Dioxide and how it relates to daily life? - EMSmastery
• ngtp-n20-manifolds-v20-sept-2023.pdf (nhscfsd.co.uk)
• Tree Planting FAQs (woodlands.co.uk)