A climate adaptation framework for NHS organisations in England

This article is an abridged version of the original text, which can be downloaded from the right-hand column. It highlights some of the publication’s key messages below, but please access the two downloadable resources (on the right and at the bottom of this article) for more comprehensive detail, full references, or to quote text. 

Summary

A draft Climate Adaptation Framework 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 centred around the development of four key capabilities. These are broken down into a series of practical, actionable tasks suitable for any NHS organisation to progress their ability to understand, prepare for and respond to climate change and its impacts.

About

Climate change has serious consequences for: 

• the delivery of healthcare service: ranging from risks to the healthcare estate, the transport networks for accessing healthcare sites and to the resilience of supply chains which provide goods and services to support. 
• public health: new pressures on the health system as a result of extreme weather events, such as heat exposure, changes to pests and diseases, and the health impacts associated with flooding.  

Understanding, anticipating, and adapting to these new challenges is essential to developing a more climate-resilient NHS. It is important to recognise that climate change disproportionately affects some people and places due to factors such as location, age, health, housing tenure, income, and other vulnerabilities.

To address the complexity of the change process required by large organisations to respond to climate change impacts, an Adaptation Capability Framework was developed by Sniffer and partners in 2018 as part of the Adaptation Scotland programme, funded by the Scottish Government. This capability-maturity approach has been successful in supporting public bodies in Scotland to deliver adaptation outcomes, used by over 50 public sector organisations to date.

Building on this work, a pilot project led by NHSE North West, NHSE North East & Yorkshire, and NHS Greater Manchester (GM) set out to draft a version of the Adaptation Capability Framework applicable for use by a range of NHS organisations in England. This resource has been produced by Sniffer and Sustainability West Midlands (SWM) as a result of this project with support from a dedicated Task & Finish Group of NHS colleagues. Other activities in this project can also be found on weADAPT under the tag #NHSadapts.

The framework also makes reference throughout to recently published Adapt to Survive risk assessment and adaptation planning toolkit for healthcare providers, developed by Sustainability West Midlands.

How to use this framework

This Framework is based on the concept that an organisation has adaptation ‘capability’ that determines its ability to adapt to climate change. The Framework is split into four capabilities that every NHS organisation will need to adapt to climate change, providing step by step tasks to guide the adaptation journey:

1. Understanding the Challenge: Adaptation is our adjustment to climate change. 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 organisational culture and resources. By developing this capability, you will find ways to align adaptation activities with your organisation’s wider organisational strategy. Over time, adaptation will become mainstreamed into plans, policies and procedures – part of business as usual for your organisation.
3. Planning & Implementation: Adaptation is an ongoing 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.

You can use this spreadsheet as a simple excel version of the tasks in the framework to track your progress.

Adaptation requires sustained, long-term commitment for an organisation – and adaptation capability will develop over time. The Framework includes maturity stages (Starting; Intermediate; Advanced; and Mature) for each of the four capabilities.

Organisations will have different maturity level along each capability and your progress completing tasks across the four capabilities may progress at different rates. For example, your organisation could be at an Advanced stage in ‘Understanding the Challenge’ but fit closer with the Starting level tasks within the ‘Planning and Implementation’ capability.

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. Pick & choose the tasks that seem most relevant to your organisation. Note: The main resource includes a high-level description of the tasks. Further guidance is included in the second resource also available to download from this article.

To get the most out of this resource

1. Look through the headline tasks in each capability to gain an initial understanding of the actions involved and how capabilities link together.
2. Consider what tasks you have completed as an organisation and therefore what maturity level you feel you are at for each capability (your baseline). This will then help you plan your future actions to become an organisation more prepared for effectively adapting to climate change.
3. Use the further guidance in the second resource available in this article to help you understand and act on the tasks suggested. Other existing resources on Climate Change, Adaptation, and its relevance to the NHS are linked to throughout the framework to explore as well.

Citation

The ‘Climate Adaptation Framework for NHS organisations in England’ is adapted from the Adaptation Capability Framework developed by the Adaptation Scotland programme, funded by the Scottish Government, and licensed under the UK’s Open Government License.

This report may be freely distributed and used for public benefit and non-commercial use. If information is used from this report, it must reference the source which is: “A climate adaptation framework for NHS organisations in England, Sniffer and Sustainability West Midlands, 2024”

Acknowledgements

As well as the main partners involved in this project, we would like to thank all the NHS staff who were involved in or consulted on the development of this resource and broader project. Thank you to our designer, Lucy Boyd, LBD design for producing the graphics and designed version of the climate adaptation framework.