Introduction

This resource has been developed to support NHS organisations to adapt to climate change.

Drawing from a model developed for the public sector in Scotland, this Framework provides a holistic approach to organisational change, for any NHS organisation to prepare for and respond to the impacts of climate change.

What is climate adaptation?

Climate adaptation is any action to reduce vulnerability to the impacts of climate change, such as extreme weather events like floods and heatwaves.

Additional information and guidance can be found on WeAdapt.

How to use this framework

Climate adaptation is not only about analysing climate data and risk models.

Effective leadership, governance arrangements, inclusive planning approaches and collaboration across teams and services are all key to successful adaptation.

This Framework is based on the principle that an organisation has adaptation ‘capability’ that determines its ability to respond to the impacts of climate change.

The Framework is split into 4 capabilities that every NHS organisation will need to adapt and become resilient to climate change, providing step by step tasks to guide the adaptation journey.

The 4 capabilities

1. Understanding the challenge

By understanding the challenge, we can make informed decisions based on actual or expected change.

By developing this capability, you will gather evidence on your organisation’s climate risks and vulnerabilities, then integrate these into internal systems and procedures.

2. Organisational culture and resources

To make progress with climate adaptation, it will need to align with your culture and resources.

By developing this capability, you will find ways to align adaptation activities with your organisational strategy. Over time, adaptation will become business as usual.

3. Planning and implementation

Adaptation is an ongoing and iterative challenge that requires strategic planning and implementation to achieve outcomes.

By developing this capability, you will set appraised options into an adaptation strategy and action plan, adopting an approach that maintains flexibility and seeks pathways for an adaptation transition.

4. Working together

No organisation can adapt alone; by working together we can do more to achieve shared adaptation outcomes.

By developing this capability, you will forge connections with key partners to share ideas and find opportunities to collaborate.

You will benefit from engaging with a diverse range of stakeholders to help shape your adaptation plans.

Maturity stages

Adaptation requires sustained, long-term action – and capability will develop over time. The Framework includes maturity stages for each of the 4 capabilities:

1. Beginner
2. Intermediate
3. Advanced
4. Mature

Organisations will have different maturity levels along each capability and your progress completing tasks across the 4 capabilities may progress at different rates.

For example, your organisation could be at an advanced stage in ‘understanding the challenge’ but more aligned to the intermediate level tasks within the ‘planning and implementation’ capability.

Tasks

The Framework includes 43 recommended tasks contained across maturity stages in each capability. By completing these tasks, your organisation will be developing capabilities and delivering adaptation.

Not all tasks will be relevant to all organisations. Choose the tasks that seem most relevant to your services and delivery model.

This resource includes a high-level description of the tasks, with further guidance and definitions on the WeAdapt website.

To get the most out of this guide:

• read through the headline tasks in each capability to gain an initial understanding of the actions involved and how capabilities link together
• consider what tasks you have completed and what maturity level you feel your organisation is at for each capability (your baseline). This will then help you plan your future actions
• use the further guidance on the WeAdapt website to help you understand and act on the tasks suggested; other existing resources on climate change, adaptation, and its relevance to the NHS are highlighted throughout the Framework

Capability 1: Understanding the challenge

1. Maturity stage: Beginner

Learn about England’s changing climate (UC1A)

An understanding of past climate trends and future projections is a necessary foundation for adaptation.

You can access localised climate information for a range of climate variables, including temperature and rainfall, and the UK climate projections provide key messages on the changes expected nationally.

Learn about climate impacts affecting health and healthcare (UC1B)

The climate is already changing, and impacts are being felt on the delivery of health services, as well as new pressures on the health system affecting demand. Learning about the impacts on the sector will help you understand current and potential implications for your organisation.

Key staff undergo basic training on climate change risk and adaptation (UC1C)

To deliver good adaptation, key staff such as service leads need to have a common level of understanding of climate change impacts and the risks to the NHS.

Relevant staff also need an understanding of adaptation and resilience.

2. Maturity stage: Intermediate

Develop understanding of climate risk and vulnerability (UC2A)

Risk and vulnerability are key concepts for understanding the potential impacts of climate change on your organisation.

To inform robust decision-making these need to be understood in your specific context, including the climate hazards most relevant to your location, and the specific vulnerabilities of communities you work with – including patients, staff and other service users.

Record the impact of recent weather events on your organisation (UC2B)

Your organisation will likely have been affected by recent weather events.

Recording the consequences of specific events with colleagues is a way to explore climate-related vulnerabilities in more depth.

Even where specific data cannot be identified, interviewing or discussing with colleagues builds a picture of the sort of impacts we can expect and can be useful narratives for raising awareness, as well as some providing initial evidence of potential costs.

Consider how your organisation’s functions (or service areas) might be affected by climate change (UC2C)

Your organisation will have many functions or departments that might be affected by climate change.

To identify these, you will need to engage with a diverse range of internal stakeholders including sustainability leads, public health, emergency response teams and estates leads at trust and system level, to explore the connection between strategic and operational priorities and climate impacts.

3. Maturity stage: Advanced

Integrate climate risk into corporate risk register (UC3A)

Use your organisation’s risk registers (at corporate or service level) to prioritise awareness, consideration and action on climate adaptation.

Undertake detailed climate change risk assessment (UC3B)

A climate change risk assessment is used to evaluate climate risks across your estates, infrastructure and operational services and functions.

The NHS Climate Change Risk Assessment (CCRA) tool is available to support this process. This strategic ‘scan’ helps to understand the changing likelihood and consequence of a range of potential risks for your organisation. It enables you to prioritise climate risks, allowing you to better focus limited resources.

Identify knowledge gaps, seek expertise and foster links with research and innovation (UC3C)

As work on adaptation advances, you seek to identify knowledge gaps that are important to your decision making.

Knowledge gaps could be addressed by seeking external expertise – and there may be opportunities to work with other NHS organisations at system level or connect with research and innovation.

4. Maturity stage: Mature

Undertake project-level risk assessment (UC4A)

Conduct a risk assessment focused on climate risks to a specific project, policy, asset, or location.

These are typically justified for operations which provide a critical function of your organisation, or are major investments and assets.

The project-level scope allows for an analysis of climate risks and identifies opportunities to embed adaptation into projects from their inception.

Integrate climate adaptation into internal systems and procedures (UC4B)

Integrate knowledge into internal systems, responsibilities and procedures, so that adaptation is not seen as an ‘add-on’ task or something that is a particular team or individual’s responsibility.

Accessible training on adaptation will help support many more people in your organisation to carry out adaptation as part of their everyday work and job descriptions.

Actively engage in sharing, learning, research and innovation (UC4C)

To meet the challenge of adaptation, your organisation will need to continually learn and adjust.

You will benefit from connecting with a range of potential partners, both locally and internationally (WT2A).

Research and innovation can be harnessed to co-produce adaptation solutions, alongside local stakeholders.

Capability 2: Organisational culture and resources

1. Maturity stage: Beginner

Consider how adaptation fits with your organisation and its objectives (OC1A)

Identify how adaptation impacts delivery of your organisation’s strategic objectives.

You will need to start to identify relevant groups and decision-making processes that will need to consider adaptation.

Identify resources available for adaptation (OC1B)

Climate change adaptation will involve many tasks requiring a range of different resources – human, physical, financial, information and intellectual.

Identify who will be involved in your adaptation work, and survey resources that already exist that will enable you to plan and deliver future work.

2. Maturity stage: Intermediate

Secure resources to plan and deliver adaptation (OC2A)

Your organisation will need committed resources – human, physical, financial, information and intellectual – to progress with adaptation.

You need to secure those needed for short-term activities – but also look ahead at likely future needs.

Consider both internal and external sources, including funding which could be accessed by linking to other policy areas such as net-zero, biodiversity and wellbeing.

Engage with colleagues to identify adaptation opportunities across functions (OC2B)

Your organisation will (or could) be delivering adaptation measures through many of its functions (or service areas).

By actively engaging colleagues across your organisation, you can identify opportunities to include adaptation in planned work – as well as identifying key teams to lead on specific actions.

Establish governance arrangements for adaptation (OC2C)

Governance arrangements are essential for effective decision- making and collaborative delivery across your organisation, providing oversight for a programme and defining roles and responsibilities.

Gain approval for an option that meets the needs of your organisation and can deliver your adaptation objectives. This could be a new group or expanding an existing board’s remit.

3. Maturity stage: Advanced

Identify opportunities to include adaptation and resilience in plans, policies and procedures (OC3A)

Take a systematic look across the breadth of your organisation’s functions to identify opportunities to include adaptation in plans, policies and procedures.

Think about where you can make the most impact.

Put governance arrangements for adaptation into operation (OC3B)

A governance group is established with appropriate authority to approve and implement change.

If required, the governance group receives appropriate training on climate risk, adaptation, and resilience to empower decision-making.

Appoint named leads within functions for specific adaptation actions or responsibilities (OC3C)

To embed adaptation across the organisation, seek to formalise adaptation roles and responsibilities taken by different functions, with named leads in place.

Mainstream adaptation into your organisation’s plans, policies and procedures (OC3D)

You can reduce reliance on stand-alone adaptation actions (which can be seen as a burden) by mainstreaming into your organisation’s functions.

Prioritise those that will deliver most impact but also embed adaptation considerations within review/update cycles for a wide range of plans, policies and procedures.

4. Maturity stage: Mature

Establish communication and reporting processes for adaptation across functions/service areas (OC4A)

As more people become actively involved delivering adaptation across your organisation, it is important to continue to recognise, support and communicate between named leads to avoid silos between service areas.

The governance arrangements should  facilitate co-ordination and oversight across adaptation actions.

This includes a mechanism for communication between service area named leads and a governance group.

Review and update governance arrangements for adaptation (OC4B)

Organisations should periodically review, reflect and update governance arrangements for adaptation.

This will help you take opportunities that arise and account for changing demands as adaptation progresses – as well respond to any wider changes in your organisation.

Capability 3: Planning and implementation

1. Maturity stage: Beginner

Define a strategic vision and outcomes for adaptation (PI1A)

Adaptation is an ongoing strategic challenge that you will need to align with your organisation’s purpose.

You should develop a ‘climate ready’ vision and define adaptation outcomes that allow you to strategically plan an effective adaptation response.

Identify a range of existing and potential adaptation actions (PI1B)

Your organisation will already be taking actions that deliver adaptation, even if they are not always recognised.

By identifying some of these actions you can demonstrate alignment with your organisation’s functions and show that you have already begun an adaptation journey.

Compile an initial set of options for actions you could take, either alone or with partners.

It is important to consider a wide range of actions, both short and long-term.

Identify relevant NHS internal structures and requirements for adaptation (PI1C)

Planning adaptation will require you to interact with stakeholders from across the NHS.

See how you fit into the existing NHS structure, mapping this out yourself if necessary.

Start conversations about adaptation with existing NHS networks and structures and identify new ways to engage with internal structures and contacts to drive adaptation.

2. Maturity stage: Intermediate     

Develop an initial adaptation strategy and action plan (PI2A)

Carry out an initial adaptation strategy which can act as a catalyst for raising awareness and resourcing further adaptation work.

At this stage, the focus is will mostly be on setting strategic objectives and capacity building initiatives.

Take action to deliver initial adaptation (PI2B)

Take early practical action on adaptation by building upon existing projects or implementing ‘no-regret’ and ‘quick-wins’ actions.

These can help raise the profile of adaptation, building internal support and helping to spur further action.

Engage with relevant NHS internal structures and processes to plan for adaptation (PI2C)

Engage with other areas of the NHS.

Start to set out an understanding of roles and responsibilities for different areas of adaptation between these structures (for example, estates, operations, community resilience).

Ensure this information feeds into your adaptation action plan (review PI2B above).

3. Maturity stage: Advanced

Develop an appraisal process for selecting adaptation actions (PI3A)

Develop an appraisal process for selecting and prioritising from an emerging set of adaptation options.

This will allow your organisation to consider a range of factors and help identify robust, acceptable, efficient and effective measures that can be taken forward in an action plan.

Develop a comprehensive adaptation strategy and action plan (PI3B)

A comprehensive adaptation strategy and action plan draws together knowledge of climate risk and appraised adaptation options (consider task PI3A) to translate your strategic objectives into practical action.

It should co-ordinate and integrate adaptation into relevant projects, policies and plans across your organisation and with partners.

Implement a programme of adaptation actions (PI3C)

Your organisation should now be ready to implement a range of prioritised adaptation actions – with appropriate resources allocated.

Beyond quick wins, programmes for longer-term strategic adaptation are being delivered across functions and across the system.

The actions should contribute to achieving your adaptation outcomes, with suitable monitoring and evaluation to learn from experience.

4. Maturity stage: Mature

Adopt an ongoing adaptive management cycle for adaptation planning (PI4A)

Develop and formalise an adaptive management cycle, applying Plan, Do, Study, Act (PDSA) principles to adaptation planning.

An adaptive management cycle is a flexible, iterative approach for decision-making when faced with uncertainty, complexity and changing conditions – and well suited to climate adaptation.

Adaptation will always be an iterative process rather than a destination as risks and vulnerabilities change.

Understanding your position within the wider NHS system will be integral to this.

Taking action on adaptation is mainstreamed into your organisation’s functions (PI4B)

For adaptation to become routine, it needs to be mainstreamed into the business-as-usual activities and key performance indicators in your organisation when delivering its functions so actions are being considered and implemented across the system.

Have system-wide adaptation plans which have resource assigned and are being delivered.

Develop a strategic change process for achieving adaptation outcomes (PI4C)

Developing a strategic approach to adaptation allows you to take account of complexity and uncertainty now and in the future.

Using methods like adaptation pathways, logic models, or theory of change you can explore a range of possible options over time – and the potential role of your organisation. 

Capability 4: Working together

1. Maturity stage: Beginner

Join and participate in relevant professional and/or adaptation networks (WT1A)

Join networks and professional institutions to develop connections with others working on adaptation.

You will benefit from shared learning and opportunities to work together, formally or informally, such as the WeAdapt platform.

Identify and engage a wide range of internal and external stakeholders (WT1B)

Delivering adaptation needs to involve a diverse range of stakeholders, both internally across functions (OC2B1), and externally including local authorities, communities, businesses and other public sector organisations.

You should identify the stakeholders that could be impacted by climate change and your adaptation. This should be considered in your adaptation work.

Consider a diverse range of stakeholders including those that you may not work with as regularly.

Authentic engagement will allow for adjustment of your plans and an opportunity for you to influence others.

2. Maturity stage: Intermediate

Develop key partnerships and opportunities (WT2A)

In the groups and networks you have identified (WT1B), speak with people about ongoing or future projects, shared priorities and potential alignment to lay the ground-work for collaboration.

From this, identify key partnerships and opportunities and start to develop these.

Continue sharing best practice and learn from each other’s successes and challenges.

Co-ordinate with partners to identify initial actions (WT2B)

Take practical action with partners to develop strong collaborative partnerships for the future.

Share your adaptation priorities and seek opportunities for joint action on adaptation.

Even small projects or co-ordination of ongoing work such as including partners in some of your own smaller adaptation actions or vice versa can build momentum.

3. Maturity stage: Advanced

Formalise partnership working (WT3A)

As you work with partners more frequently and on larger projects, you will need to formalise partnership arrangements – agreeing roles, responsibilities and any funding allocations.

This might build upon existing arrangements or might need you to establish a new partnership.

Develop communication and engagement activities with partners (WT3B)

Highlight and communicate shared priorities, climate risks, and ongoing adaptation actions with partners.

Use this communication to emphasise the importance of your collective action, internally and externally.

Consider streamlining or increasing the effectiveness of your community resilience communications and similar by joint communications with partners.

4. Maturity stage: Mature

Expand a programme of longer-term joint actions (WT4A)

Ongoing collaboration with partners can help you deliver an expanding range of adaptation actions and achieve shared outcomes.

It is likely that many adaptation actions cannot be effectively delivered without the involvement of partners.

Partnership working could enable new funding opportunities.

Take a lead in networks and peer organisations (WT4B)

As an organisation that is now a leader on adaptation, you will have invaluable experience to share – and much still to learn.

Your adaptation work will be strengthened when others are progressing, so take an active role in networks and connect with peer organisations.

Annex A: Maturity stages at a glance

Understanding the challenge

Organisational culture and resources

Planning and implementation

Working together

Publication reference: PRN01719_i