Foreword

Our climate is rapidly changing. With 6 of the last 10 years (2014-2023) ranking among the warmest on record since 1884, the impacts are already proving costly to both society and the NHS, with future costs expected to rise.

While estimating the full extent is challenging, heat-related mortality in England alone costs £6.8 billion annually, likely to increase to £14.7 billion per year by the 2050s. These figures underscore the urgent need for action.

Despite rapid decarbonisation, global temperatures will continue to rise, and without adaptation, health impacts from heat, cold and flooding will worsen due to climate and sociodemographic changes.

Emissions reduction and climate adaptation are mutually reinforcing, essential aims to minimise the adverse effects on population health and health services.

The health sector’s resolve to adaptation is ever more essential given the vulnerability of the population we serve.

Health system adaptation demands strong leadership to integrate climate data, assess local vulnerabilities, empower the workforce, and allocate resources to reduce climate-related risks to health, healthcare infrastructure, and supply chains.

Recognising this, the NHS became the world’s first health system to commit to reaching net zero emissions, with the Health and Care Act (2022) reinforced this commitment, placing new duties on integrated care boards (ICBs), NHS trusts and foundation trusts to consider statutory emissions and environmental targets in their decisions.

Importantly, it also requires health services to adapt to both current and predicted climate impacts, as outlined in the Climate Change Act (2008).

As a fundamental public health issue, climate change is likely to exacerbate existing health inequalities without targeted adaptation measures, as the impacts of climate change will be unevenly distributed across society.

Tackling this requires close collaboration across sectors – including industry, local authorities, the NHS, social care, and the communities they serve.

The public health workforce is uniquely positioned and equipped to lead this whole-system approach to adaptation.

However, driving forward the adaptation agenda across the health system will require the full engagement and support of the entire health workforce.

This 4th health and climate adaptation report builds upon our 2021 report. Drawing on stakeholder and expert insights, it outlines the progress made in building resilience, identifies further opportunities for adaptation, and provides recommendations for the health sector.

The ambition of this report is to help local, regional, and national teams prepare for and respond to climate change while delivering on statutory net zero commitments, ultimately creating more resilient health systems that support whole population health and wellbeing.

Introduction

Climate change and health

The last 3 decades across the UK have been progressively hotter, with 2023 being the second warmest year on record after a record breaking 2022.

All areas in the UK have experienced warmer summers and milder winters, consistent with global trends.

These rapidly rising global temperatures, now 1.1°C above pre-industrial levels, are set to exceed 1.5°C without additional near-term action.

The impacts will continue to negatively affect the health of the UK population unless necessary prevention and adaptation measures are implemented.

Impact on population health and health services

Climate change threatens the health of the population and the ability of the NHS to deliver its essential services in both the near and longer term.

More frequent and severe floods and heatwaves are among the impacts the UK is already experiencing in our changing climate, with estimated total heat-associated mortality of 2,985 in England during the temperatures of summer 2022.

Every increment of global warming will intensify these hazards. The 2022 UK Climate Change Risk Assessment (CCRA3) states that climate change will increase the risk of operational disruption in health services from flooding and heatwaves.

Interruption to critical services (water, energy, transport, supply chain) may further undermine healthcare delivery.

Impacts are expected to be felt in institutional settings (such as overheating in hospitals) and have negative impacts on health workers as well as patients.

CCRA3 also identifies key population health risks from climate change, including increased heat-related illnesses, worsening air quality, vector-borne diseases (VBDs), and mental health impacts from extreme weather events.

As indicated in the latest Lancet Countdown report, the health threats of climate change have reached record-breaking levels.

Climate change risks intersect with existing health and social inequalities, disproportionately affecting populations who have limited control over their environments, fewer resources to adapt their behaviours, and less capacity to respond to new threats.

Those most at risk include:

• older adults
• those with a physical or mental health condition
• children
• individuals with disabilities
• people experiencing deprivation or homelessness
• those in settings such as prisons, schools, and social care settings

These populations closely align with the CORE20PLUS Framework, which is used by NHS England and the UK Health Security Agency (UKHSA) to identify those likely to experience health inequalities, and requiring routine consideration in our work.

Without sufficient adaptation, the direct and indirect impacts of climate change will be unevenly distributed across society, potentially widening existing health and broader inequalities and undermining the strategic goals of the health system to improve health and reduce premature mortality.

Climate change adaptation

Climate change is already here. There is a clear and immediate need for the healthcare sector to reduce its carbon emissions to net zero, and to adapt to the impacts of climate change that cannot be avoided, building resilience into the system as it protects and promotes the health of current and future populations.

With overwhelming support from its 1.5 million staff, the NHS Net Zero Strategy plots an ambitious and feasible set of actions to respond to climate change. The strategy also commits to building resilience and adaptation into the heart of the net zero agenda.

Health equity effects should be proactively factored into policies, decisions and actions, reflecting due regard for the Public Sector Equality Duty (PSED) under the Equality Act (2010), and duties relating to health inequalities introduced by the Health and Care Act (2022).

Background and purpose

This report has been developed in response to the Department for Environment, Food and Rural Affairs’ (DEFRA) request for NHS England and UKHSA to provide an updated assessment of climate risks to the health sector.

It is a key component of the 4th round of adaptation reporting (ARP4) and feeds into the government’s 5-year adaptation policy, risk assessment, and planning cycle, as enshrined in the Climate Change Act (2008).

This report updates on progress since the 3rd Health and Care Adaptation Report (2021), building on the actions outlined in the 3rd National Adaptation Programme (NAP3). The report serves multiple purposes:

• To summarise any new information or updates on climate risks and actions since the previous reporting round.
• To assess progress toward completing the actions identified in the last reporting cycle.
• To identify new actions needed to tackle climate risk in the health sector.
• To present case studies that demonstrate effective adaptation strategies already in practice.

Scope

The 3rd Climate Change Risk Assessment (CCRA3) identifies 5 key climate-related risks directly relevant to the health sector:

• H1: Risks to health and wellbeing from high temperatures
• H3a: Risks to people, communities, and buildings from flooding
• H7: Risks to health and wellbeing from changes in air quality
• H8: Risks to health from vector-borne diseases
• H12: Risks to health and social care delivery (with this report focusing on the healthcare delivery aspect of this risk)

This report is geographically focused on England, recognising that devolved administrations have separate reporting arrangements.

The scope of the health sector includes NHS trusts, ICBs, primary and community care services, health and wellbeing boards, and the public health system.

Social care, while important, is outside the direct scope of this report.

As outlined in the 3rd National Adaptation Programme (2023), the Department of Health and Social Care (DHSC) and UKHSA will work with social care providers to better understand how to adapt social care infrastructure and raise awareness of the health consequences of climate change.

Methodology and engagement

To meet the objectives of this 4th adaptation report, NHS England and UKHSA have revisited and assessed climate risks from (CCRA3) through a structured evidence-gathering process. Given the scale and complexity of the health sector, extensive stakeholder engagement was essential.

A working group involving national health sector leaders provided oversight and direction for this report.

In addition, a call for evidence was open for 6 weeks in August and September 2024, allowing stakeholders, NHS bodies, and public health organisations to submit data, evidence, and case studies illustrating climate impacts and successful adaptation efforts.

This evidence-gathering process was further supported by 2 roundtable discussions with NHS and public health representatives from every region in England, which provided a platform for more in-depth dialogue on adaptation challenges and opportunities.

This process of gathering, analysing, and synthesising evidence was essential to ensuring that the report captures both the breadth and depth of climate risks faced by the health sector and the steps taken to address them.

Structure

To provide a systematic and practical analysis of health sector adaptation, this report follows the World Health Organization’s (WHO) Operational Framework for Climate-Resilient Health Systems.

The report is organised around 3 key building blocks of the WHO framework:

1. Health information systems – Including the role of data and surveillance in identifying and responding to climate risks, such as tracking disease patterns, air quality, and health outcomes related to extreme weather.
2. Service delivery and infrastructure – Assesses the resilience of healthcare facilities and delivery systems, including buildings, supply chains, and digital infrastructure, against extreme weather events.
3. Leadership, workforce and resourcing – Explores leadership, governance, and workforce capacity in driving adaptation efforts, maintaining service continuity under climatic changes, and ensuring sufficient resources are allocated to climate resilience.

Health information systems

Background

Health information systems are fundamental to effective climate adaptation in the health sector, serving dual purposes: supporting immediate action in response to an extreme weather event, and enabling long-term monitoring and prevention.

Health information systems provide data and insights to quantify climate-related health risks, guide timely interventions, and track resilience progress by integrating data from sources like mortality and syndromic surveillance, hospital statistics, and service disruption reports.

They also facilitate research, risk monitoring, and early warning systems, helping professionals identify and act upon emerging risks and intervention opportunities.

In assessing climate-related health risks, health information systems enable analysis of environmental hazards, exposure, and vulnerabilities, making them central to proactive climate adaptation in the health sector.

The NHS, UKHSA and the Care Quality Commission (CQC) work together to monitor the impacts of climate change on health and service delivery, and several mechanisms exist within the sector to assess risk and project disease burden.

Health information systems in practice

Public health surveillance

Systems such as the UKHSA Syndromic Surveillance system provide near real-time data on health impacts related to extreme weather events, monitoring health outcomes like syndromic trends during heatwaves, cold spells, or floods.

Mortality data also play an important role in understanding the broader impacts of these events.

Vector surveillance

Surveillance and research for vectors is essential to inform public health risk from vector-borne disease.

UKHSA conducts surveillance and research together with a range of partners including local authorities, DEFRA, Forestry England, wildlife trusts, Natural England and wildlife charities, and runs public-facing surveillance schemes, whereby information is provided to submitters.

Data facilitates risk assessments on current and emerging vector borne disease and provides input into climate change planning.

Warning and alerting systems

Early warning systems play a crucial role in preparing health services for the impacts of extreme weather by providing timely alerts that allow for preventive measures.

UKHSA has partnered with the Met Office to integrate climate science and modelling into health impact assessments. In 2023, this collaboration led to the launch of an impact-based Weather-Health Alerting System.

This system provides local responders with actionable information, helping them understand and anticipate the potential health impacts of adverse weather and determine the necessary actions to mitigate risks and protect vulnerable populations.

Since its introduction in April 2023, subscriptions to the new weather health alerts have reached 41,369 (as of October 2024).

Ongoing monitoring and frameworks

Since 2021, frameworks to support resilience in the health sector have been developed, in line with commitments outlined in the previous report.

In April 2023, the UKHSA launched the Adverse Weather and Health Plan. The plan provides a comprehensive framework, outlining how various sectors including public, independent, voluntary, health, and social care organisations and local communities can collaborate to improve planning and response arrangements during adverse weather.

The CQC has built the capability to assess climate adaptation within its new Assessment Framework launched in 2023.

Climate adaptation is now explicitly included in 2 quality statements:

• Safe Environments – this focuses on ensuring that services are prepared for, and resilient to, adverse weather events.
• Governance, Management and Sustainability – this considers services’ emergency preparedness planning.

This approach allows CQC to evaluate and promote climate resilience within registered organisations, ensuring they are taking a proactive approach to addressing climate risks.

While current systems and frameworks capture valuable data on climate impacts and adaptation, stakeholders highlighted the need for further support in translating this information into long-term risk assessments, adaptation planning and ongoing monitoring and evaluation to inform future action.

They noted that although significant data and resources are available, many face challenges in applying this information to their specific contexts due partly to limited access to practical tools and training.

Stakeholders expressed a desire for clearer signposting of existing data and user-friendly training to help public health and healthcare professionals make evidence-based decisions.

An approach to address some of these challenges, through new guidance and training, is outlined in the following chapters.

Health and climate research

Recent developments in health and climate research demonstrate a growing focus on addressing the health impacts of climate change.

UKHSA established the Centre for Climate and Health Security in 2022 to co-ordinate efforts to protect public health from climate-related risks. The centre works closely with academia to improve understanding of the health effects of climate change and develop effective interventions.

The 4th Health Effects of Climate Change Report, published by UKHSA in 2023, consolidates the latest evidence to inform policy and actions to safeguard health in a changing climate.

UK Research and Innovation (UKRI) launched the Maximising UK Adaptation to Climate Change Hub, which aims to bring together expertise across sectors to support the development and implementation of a national climate change adaptation plan, translating findings into practical strategies.

UKRI has also called for the establishment of a centre in climate change and health to find solutions to climate-related health challenges, focusing on delivering impact within 5 years.

Furthermore, the National Institute for Health and Care Research (NIHR) has committed £25 million over 5 years to support the decarbonisation of health and social care.

As the health sector moves into the implementation phase of climate adaptation, there are key areas where research and innovation can further support these efforts.

A primary area of focus is the evaluation of climate adaptation interventions in healthcare settings.

Assessing the effectiveness, feasibility, and cost-benefits of various interventions will provide valuable insights, helping guide future investments and ensure adaptation efforts deliver maximum impact.

There are also remaining gaps that, if addressed, would strengthen the case for change. A comprehensive assessment of the costs to the health sector from extreme weather events is needed, including both direct disruptions and indirect or unreported impacts.

For example, while NHS Estates Return Information Collection (ERIC) data captures incidents that trigger risk assessments, it does not capture the effects on services, such as care disruptions, infrastructure damage, and financial costs. Additionally, some incidents may go unreported, further limiting our understanding of the totality of the sector’s vulnerability.

To address these gaps in knowledge, particularly related to implementation, NHS England and UKHSA will work closely with the research and innovation community to explore opportunities for further study. Nevertheless, while there is scope to deepen our understanding, progress should not be delayed in waiting for additional evidence.

Climate impacts are already being felt, and valuable learnings will emerge as actions are implemented and evaluated.

What is the research and data showing us?

Heatwaves pose an immediate threat. Reports from UKHSA (and previously Public Health England) show that between 778 and 2,556 heat-associated deaths occurred each summer across all age groups in England from 2016 to 2021.

In 2022, when temperatures reached 40°C for the first time, 2,985 heat-associated deaths were recorded across all age groups associated with 5 heat episodes, the highest number in any given year.

Projections suggest heat-related deaths will increase nearly 6-fold, rising from 1,602 per year (2007-2018 baseline) to 10,889 per year by the 2050s without adaptation and decarbonisation efforts.

Excess winter death metrics do not delineate the impacts of cold alone from other seasonal impacts that could affect mortality. These figures fluctuate considerably, so a 5-year moving average is used to identify underlying trends in mortality.

Since 2000, these average annual deaths have remained high at approximately 30,000 deaths per year. Reports from UKHSA suggest cold-related deaths could increase from 41,759 (2007-2018 baseline) to 61,287 per year by the 2050s without adaptation and decarbonisation due to our aging population.

Climate change impacts also extend to increased flooding, water scarcity, worsening air quality, and the spread of vector-borne diseases. For example, in recent years, UKHSA’s surveillance activities have identified invasive mosquitoes in the south of England and UKHSA has worked with partners in control measures to prevent the establishment of these mosquitoes in the UK.

These climate hazards threaten both physical and mental health. During consultation, stakeholders perceived that the risks of climate-related impacts on population health have increased, with high temperatures and flooding the most cited as having intensified.

Health equity was a consistent theme throughout engagement, with stakeholders emphasising the disproportionate nature of climate-related risks and impacts, as evidenced through multiple mechanisms.

To address these risks, comprehensive public health strategies such as early warning systems, infrastructure resilience, and inclusive community-based interventions will be critical to reduce the long-term health impacts of climate change, protect at risk populations and help reduce inequalities.

The NHS England ERIC system enables the tracking of climate-related incidents in health services.

Provisional data shows a 53% rise in overheating incidents triggering a risk assessment from 2016/17 to 2023/24, with a peak in 2022/23 likely reflecting the record 40-degree temperatures in July 2022.

Flood incidents, monitored since 2020/21, have increased by 103%, rising steadily from 176 to 358 occurrences by 2023/24.

These trends highlight growing environmental stressors and the need for stronger climate adaptation in healthcare.

Next steps

UK Health Security Agency

• Commission an evaluation of the implementation of the Adverse weather health plan to:

1. conduct a process evaluation of the implementation of the Adverse weather health plan in local health and social care organisations in England
2. explore the key barriers and facilitators to local implementation
3. feed into UKHSA’s efforts to best support these organisations in the implementation of the plan

• Develop a framework for monitoring and evaluating the Weather-Health Alerting system to allow UKHSA to monitor the use and usefulness of the system among those registered to receive the alerts and to assess the impact alerts are having in driving action and on observed impacts during hot and cold weather.
• Identify and assess key current and future climate related risks to public health and on health inequalities through regular scientific assessment and reporting, commencing with a report covering the mental health impacts of climate change and with subsequent topics being informed through ongoing engagement with UKHSA’s partners.
• Explore the use of digital products and services to enable UKHSA to facilitate access to the latest evidence, best practice and tools to drive action by UKHSA’s partners concerning the impacts of climate change on health.
• Develop national toolkits and guidance to support adaptation. This will include developing or hosting the provision of products, services, and training to improve accessibility of data, evidence, indicators, and metrics and understanding impacts on different communities.

Care Quality Commission

• Explore how data can be used more effectively to identify, track and report on climate-related service interruptions in CQC’s provider assessments and in CQC’s national reporting.
• Develop and improve guidance to support the Assessment Framework to deliver consistent assessment and reporting on healthcare providers’ preparedness for adverse weather events.

NHS England and UKHSA

• Collaborate with the research and innovation community to explore opportunities for further study that address implementation gaps to support climate adaptation efforts.

Service delivery and infrastructure

Background

Service delivery and infrastructure in the health sector refers to the systems, processes, and physical facilities that enable healthcare services to be provided effectively to patients.

This encompasses hospitals, clinics, primary care facilities, and the networks that support healthcare workers in delivering care.

Service delivery involves the provision of health services, from emergency care, prevention and routine consultations, while infrastructure includes the physical buildings, equipment, and energy systems needed to sustain these services.

Together, they form the backbone of healthcare systems, ensuring that patients receive the necessary care in safe, accessible and equitable environments.

The scale and complexity of delivering high-quality healthcare across England are substantial.

The NHS alone generates nearly 10 billion road miles annually, accounting for 3.5% of the UK’s total, underscoring the vast logistics required to connect hospitals, clinics, communities, and our network of 80,000 suppliers who provide up to 592,000 different types of medical products.

With over 1.5 million employees, the NHS is Europe’s largest employer and the 5th largest in the world, with 1 in every 25 working-age adults dedicated to providing care. This workforce is distributed across 16,000 buildings in acute care, mental health, ambulance, and community services, alongside over 6,000 general practices.

In addition, the NHS operates a fleet of 20,800 vehicles – the country’s 2nd largest, behind the Royal Mail – all essential to sustaining care delivery across diverse settings.

The size and scale of the NHS makes it a key anchor institution, with the ability to strategically use its assets and resources to positively support local communities beyond healthcare services, enhancing the social determinants of health.

Risks and impacts

Climate change poses significant risks to both service delivery and healthcare infrastructure.

Rising temperatures, extreme weather events, and shifting disease patterns place increasing pressure on health services and the physical infrastructure that supports them.

For example, extreme heatwaves can increase patient admissions for heat-related illnesses and increase risk of overheating in health facilities, putting additional pressure on emergency services.

Flooding and storms can disrupt the supply to, and operation of healthcare facilities, causing physical damage, leading to temporary closures, or requiring costly repairs, as well as impact on staff and patients.

Additionally, energy, supply chain, water and transport system disruptions could hinder the delivery of essential services.

The impacts of severe weather events, along with increased patient demand, will require significant adaptation measures to ensure the NHS can continue to deliver safe, effective, and timely care in a changing climate.

Progress to date

Since the publication of the 3rd health and care adaptation report, progress has been made in improving the climate resilience and adaptation of healthcare service delivery and infrastructure across the NHS.

Central to this effort are the NHS Emergency Preparedness, Resilience and Response Core Standards. These standards mandate that all NHS trusts maintain robust business continuity plans to ensure service continuity during major events such as flooding, extreme heat, or severe cold.

This approach provides an essential framework for responding to acute climate-related incidents, enabling healthcare facilities to maintain critical operations and minimise major service disruptions.

However, the changing climate presents an ongoing, evolving risk that extends beyond the scope of acute incidents and requires proactive management beyond business continuity plans.

To address this, the NHS recognises the need for comprehensive, strategic adaptation planning aimed at reducing impacts and service disruptions. This involves delivering targeted interventions to adapt healthcare sites, services and supply chains based on a thorough understanding of local and systemic climate risks.

Such measures are integral to creating an overarching organisational adaptation strategy that builds long-term resilience into the health system.

To move towards this aim, NHS England has introduced several key measures to support NHS trusts and ICBs in comprehensive adaptation planning.

One of the most significant developments is the creation and publication of the NHS climate change risk assessment tool. Developed in collaboration with partners across the health sector, this tool helps organisations to identify and evaluate local climate risks specific to NHS sites and services, facilitating collaboration among various workforces and teams involved in climate change adaptation.

The tool was piloted by 22 trusts and 4 ICBs, during which feedback was collected to refine its usability and relevance.

As a result, improvements were made, including the addition of a comprehensive list of climate impacts across a range of areas including, but not limited to impacts on:

• health service demand
• essential supplies
• equipment
• infrastructure
• subsequent impacts on staff and patients

A user guide has also been introduced with step-by-step instructions and resources. This ensures that organisations can effectively navigate the tool, plan for long-term resilience, and support system leaders in understanding cumulative climate risks across local services.

The climate change risk assessment tool may also support organisations to comply with the Taskforce on Climate-Related Financial Disclosure (TCFD) reporting requirements where relevant. Specific guidance for NHS organisations is available in the Group Accounting Manual.

Additionally, the NHS has strengthened adaptation provisions within the NHS Green Plan Guidance. This guidance outlines specific actions for trusts and systems to integrate into their organisational green plans, focusing on climate adaptation over the next 3 years.

By embedding climate resilience within broader sustainability strategies, the NHS ensures adaptation is not an isolated effort but an integral part of ongoing organisational planning.

The NHS Standard Contract has also been updated to mandate that all providers actively mitigate risks related to climate change and severe weather. This contractual requirement ensures that healthcare premises and services are not only prepared for future climate impacts but are also proactive in enhancing their resilience to withstand these challenges.

In addition to these measures, the NHS Net Zero Building Standard plays a role in supporting climate resilience in healthcare facilities.

The Standard incorporates thermal comfort assessments and passive cooling measures to minimise overheating in healthcare facilities, an increasingly important consideration as temperatures rise due to climate change.

Furthermore, the Standard emphasises energy efficiency, ensuring that building fabric performance is optimised in both new builds and retrofit projects.

This approach enables facilities to maintain comfortable temperatures with reduced energy use, thereby decreasing operational costs and environmental impacts while improving the resilience of healthcare infrastructure.

To support the NHS to predict and mitigate risk, reduce vulnerabilities, and develop effective resilience strategies to climate change-related supply chain disruptions, meaningful data-sharing policies and protocols should be established across the healthcare value chain.

The first priority outlined in the government’s Medical Technology Strategy is resilience and continuity of supply.

One of the ways that DHSC has committed to improving NHS supply resilience and responding to the growing threat to health posed by climate change is by transitioning towards circular medical technology products, where the recently published Design for Life roadmap outlines 30 actions to be delivered in collaboration with stakeholders.

Engagement feedback and insights

Stakeholder engagement revealed that over 70% of participants believe the magnitude of risk to health and social care delivery (H12) from climate change has increased since 2021. This was supported by a range of evidence, including direct experience of service disruptions and a mismatch between projected risks and the resources available to address climate-related impacts.

To tackle this, participants stressed the need for comprehensive adaptation strategies to strengthen resilience, and the importance of integrating climate risk assessments, infrastructure strengthening, staff training, and data surveillance into these strategies. There was strong support for moving away from siloed approaches and embedding adaptation into core business functions, alongside a preventative approach to managing risks.

Cross-sector collaboration was identified as essential, especially between health and local authorities. Sharing risk assessments and planning jointly will improve the sector’s ability to maintain service continuity during extreme weather events.

Stakeholders also highlighted the value of exploring innovative approaches to service delivery, such as digitalisation, to improve access to care in adverse weather conditions. For example, the use of digital healthcare services could help maintain service continuity, even when physical access to facilities is compromised by extreme weather.

In adopting any new approaches, it is essential to consider the needs of those without reliable digital access, ensuring all population groups can still receive the necessary care and support during adverse weather events.

Finally, participants expressed a strong aspiration for a collaborative, inclusive community-driven approach to adaptation. Building climate resilience from the ground up, by involving local communities in the planning process, was viewed as key to addressing health inequalities. Co-developing solutions with communities ensures that adaptation measures are inclusive and tailored to the specific needs of communities most at risk from the impacts of climate change.

Next steps

Locally led climate risk assessments and adaptation planning will be essential to tailor actions to the specific needs of local health services, sites, and geographies.

Aligning this work with emergency preparedness, resilience and response standards and BCPs will be crucial in reducing the severity and likelihood of climate impacts, ensuring resilience during both acute and non-acute events.

Key actions – NHS ICBs and trusts:

• Develop green plans with a stronger focus on climate adaptation, detailing actions to improve resilience over the coming years.

NHS trusts

• Complete the NHS CCRA tool, with NHS England providing ongoing support and monitoring its uptake to ensure that comprehensive and accurate climate risk assessments inform local adaptation strategies.
  • Identified risks and impacts should be shared with systems and resilience partners (for example, local resilience forums and directors of public health) to ensure critical information is integrated into broader emergency planning and climate adaptation planning practices to enhance overall system resilience and preparedness.

NHS England

• Update the NHS Net Zero Building Standard and Health Building Note 00-07, reflecting the latest best practices in climate resilience.
  • These updates will ensure that healthcare infrastructure projects, both new and existing, incorporate enhanced measures for mitigating climate impacts and maintaining operational continuity in extreme conditions.
• Conduct an emergency response exercise on adverse weather and health in every NHS region by 2030.
  • These exercises will assess response capabilities, communication pathways, and resource coordination among NHS organisations and partners.

UKHSA, with support from NHS England

• Update off-the-shelf training exercises for adverse heat and adverse cold weather to enable NHS teams and partner to plan for future adverse weather and mitigate impacts.

Leadership, workforce and resources

Background

Leadership, workforce, and resourcing within the healthcare sector is integral to build resilience from the impacts of climate change on health care delivery. Achieving this requires strong leadership, adequate resourcing, and a workforce equipped with a detailed understanding of climate change adaptation.

Strengthened leadership at regional and local levels across the NHS, UKHSA, and the wider health system is essential to drive adaptation programme implementation. This includes the establishment of UKHSA’s Centre for Climate and Health Security in October 2022 to provide national leadership on climate change adaptation for health security.

The Faculty of Public Health aims to ensure that the public health workforce lead on strategies to protect health and wellbeing from the impacts of climate change and maximise the health co-benefits of carbon reduction interventions.

Public health leaders in local authorities already work in partnership to implement initiatives to improve and protect health within communities. They are uniquely placed to ensure initiatives are implemented effectively and targeted to the highest risk population groups, especially within local authorities, but also across the NHS within integrated care systems.

Health and wellbeing boards already convene the political, professional (including public health), clinical and community leads to improve local population health and wellbeing and reduce health inequalities, which already targets populations that are likely to be more vulnerable to climate change.

Progress in workforce development has so far targeted individuals in positions with explicit responsibilities for adaptation, often within a net zero agenda or those with a personal interest in supporting climate change mitigation or adaptation.

However, all staff across the health system need to have the necessary skills and resources to shape the adaptation of health services by identifying specific opportunities to adjust system delivery alongside providing excellent clinical care.

This requires staff to be provided with protected time to develop and apply the required skills and capabilities within the workforce and recognition of this work within individual workplans.

Specific roles that stakeholders suggest could support targeted expertise and leadership for climate adaptation with support include occupational health, health protection and emergency preparedness, resilience and response.

Addressing the drivers of vulnerability beyond the health sector is equally critical. Comprehensive understanding and management of climate-related health risks originating from other sectors – such as food, water, energy, housing, infrastructure, and transport – require both political leadership and system-wide collaboration.

Leadership within the health workforce alongside political leadership and system collaboration is essential to support health sector climate adaptation. Co-ordinated financial support is also necessary to maximise the protective impacts of adaptation efforts.

Building resilience to climate change in the health system requires a prepared, empowered workforce capable of leading and implementing adaptation interventions.

The NHS is the largest health system in the world and has over 1.5 million employees. Training employees to acquire the required technical skills to use climate information and population data to inform decision making, manage evolving risks to health systems of climate change and synergise health and non-health information for decision making is essential to build capacity on climate change and health.

Finally, organisations need targeted resources, information, and processes to improve their capacity for climate adaptation.

Strengthened collaboration across sectors is key, as is building awareness and capability to communicate uncertainty around climate risks and identify appropriate means to responsibly, constructively, and inclusively deliver important information to communities at risk.

Progress update on actions

Every trust and ICB has a board-level net zero lead and delivers climate change duties through a board-approved green plan. However, stakeholder engagement findings suggested that there is a need for strengthening and clarity surrounding leadership in climate adaptation.

While there is legislation for NHS England activities surrounding adaptation, integration and embedding of climate change adaptation into non-NHS strategies through collaboration across sectors including charities and local authorities is critical.

The consistency of the National Adaptation Programme to provide an update on existing climate change risks that require adaptation provides a means to support long term planning.

However, stakeholders were concerned the long-term approach within legislation and policy is not being married with similar long-term funding commitments or sustained resources to support effective yet efficient adaptation planning.

This echoes the UK Climate Change Committee’s 2023 recommendation to DHSC to make available long-term, protected funding to adapt hospitals, care homes and other healthcare buildings to the impacts of climate change.

Across the NHS, workforce training for climate adaptation has been strengthened in existing e-learning offers through the e-learning for healthcare platform. The Carbon Literacy for Healthcare e-Learning pathway includes material to support green champions in identifying population groups most at risk of climate change and extreme weather events, alongside the impacts of heatwaves and flooding on healthcare delivery.

This single day, blended learning module for green champions and those newer to net zero role has been accessed by approximately 3,000 staff.

The NHS Leadership Academy has developed and implemented a Sustainability Leadership for Greener Health and Care Programme (accessed by over 900 leaders), which also includes training material on the impacts of climate change on health delivery, to equip system leaders across the public sector with the tools and knowledge to build a sustainable health system.

Next steps

UKHSA

• Explore the possibility of regional health protection teams having climate change adaptation leads with consistent roles.
  • Stakeholders highlighted variability in how climate adaptation is embedded across health protection teams, suggesting that clearer mandates could drive positive change.
• Engage with the Faculty of Public Health and the Association of Directors of Public Health to integrate expertise from public health to support adaptation to evolving climate health risks.
  • This will support directors in public health to advance climate adaptation for health and care to minimise health inequalities.
• Collaborate with the Faculty of Public Health and Association of Directors of Public Health to identify learning needs for public health professionals and deliver training for the relevant workforce groups.

NHS England

• Develop training to empower the NHS workforce to lead and deliver climate adaptation.
  • Existing training includes adaptation within carbon literacy and/or net zero training programmes.
  • Adaptation-specific training that is bite-sized would itself become more accessible and improve broader understanding within the workforce of the need for healthcare adaptation.

Conclusion

This 4th health and climate adaptation report highlights the progress made in strengthening the resilience of the health sector to the growing impacts of climate change.

However, it also underscores the challenges that remain, such as addressing vulnerabilities, improving infrastructure, and empowering the health workforce to lead and deliver adaptation efforts.

As the sector moves into a critical implementation phase, the focus must shift to translating insights into practical strategies that safeguard public health, protect populations most at risk, and ensure the continuity of equitable healthcare services for all, under increasing climate pressures.

As climate risks such as heatwaves and flooding intensify, immediate and coordinated action is needed. While the groundwork has been laid, further work needs to be done to ensure healthcare systems, facilities, and supply chains can withstand future climate pressures and continue to deliver safe, effective, and accessible care.

The public health sector plays a pivotal role, using data to identify risks, inform policy, as well as prioritise and implement interventions that contribute to more equitable outcomes. Public health expertise is crucial in ensuring adaptation measures are inclusive and targeted, addressing the disproportionate impacts of climate change on communities.

Leadership, workforce capacity and cross-sector collaboration remain essential for successful adaptation. Empowering health professionals with the tools and knowledge to integrate climate data into decision-making is critical to building resilience. Public health practitioners will need to work closely in partnerships with the NHS, local authorities and diverse communities to co-design and implement locally relevant adaptation measures.

As the sector moves forward, it must build on progress by embedding climate resilience into leadership structures and governance, securing resources, and fostering collaboration.

By prioritising adaptation and embedding it within our net zero commitments, the NHS and public health system can lead the way in creating a resilient healthcare system capable of protecting health from the impacts of climate change.

Publication reference: PRN01366
Classification: Official