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The study, commissioned by Health Facilities Scotland, found that NHS Scotland's carbon dioxide emissions made up nearly a quarter of the public sector's as a whole. However, the 2.63 megatonnes (Mt) of CO2 represented just 3.6 per cent of Scotland's total.

The breakdown of emissions given in the report shows that, in 2004:

• Travel, including patient and staff transport, accounted for 24 per cent of carbon dioxide emissions
• Building energy use, including heating and lighting, across the NHS Scotland estate accounted for 23 per cent of the total
• 'Procurement', including everything from the energy needed to produce medicines to catering and freight transport, was 52 per cent of the total.
• Within procurement, the production of pharmaceuticals and medical instruments accounted for 18 per cent and seven per cent of all emissions respectively.

But while CO2 emissions fell by four per cent from 1990 levels overall, the decline was uneven. For example, while emissions from buildings' energy use fell by 34 per cent, those from procurement rose by 20 per cent.

In response, the Scottish Government is proposing new targets to monitor NHS boards' progress in reducing their carbon emissions and improving energy efficiency. Driving down procurement emissions will also be a key priority going forward.

Greater use of the hi-tech eMART monitoring system means that from now on energy use in all NHS Scotland buildings can be measured, improving the accuracy of future carbon footprint estimates.

Health Secretary Nicola Sturgeon said:

"Today's carbon footprint report for NHS Scotland - the first of its kind - gives us a snapshot of how our emissions are broken down and a firm base to work from as we seek to reduce them.

"The report covers the period from 1990 to 2004 and we have made significant progress since then, such as the creation of the centralised NHS Scotland National Procurement which is helping to cut costs and emissions. Individual NHS boards are also showing great innovation with their own green initiatives. However, it's clear that we have to do more.

"Scotland is rightly proud of having enacted the most ambitious climate change legislation in the world. But all organisations, including the NHS, must play their part if we are to reach our goal of an 80% emissions cut by 2050."

Duncan McLaren, Chief Executive Friends of the Earth Scotland, said:

"We're pleased to see NHS Scotland taking its responsibility for managing greenhouse gas emissions seriously.

"This report sets a particularly good example for others in including all the emissions the NHS can influence, including those arising from procurement and from patient and visitor travel.

"This report also reveals the challenge faced by the NHS, as a major part of the public sector, to fulfil its duties under the Climate Change Act to act in the way best calculated to reduce emissions in line with Scotland's climate change targets."

Mike Thornton, Director, Scotland, for the Energy Saving Trust, said:

"In Scotland, the Energy Saving Trust offers a free travel planning advice service to all organisations and businesses.

"We have worked closely with bodies such as NHS Tayside to create a plan of action to tackle the pressure on parking at key sites such as Ninewells Hospital in Dundee, while at the same time promoting more environmentally friendly and healthier travel options for staff."

NHS progress is measured by HEAT targets, a core set of Ministerial objectives, targets and measures for the NHS. HEAT targets are set for a three year period and progress towards them is measured through the Local Delivery Plan process.

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