Developing adaptation capability of the NHS in England – a pilot project

Context

Climate change has serious consequences for both public health and effective delivery of healthcare. The risks and potential consequences are recognised in the UK Climate Change Risk Assessment (UKCCRA3), summarised in the health and social care briefing produced in 2021. Understanding, anticipating, and adapting to these new challenges is essential to developing a more climate-resilient NHS.

In recognition of this, NHSE North West, NHSE North East & Yorkshire, and NHS Greater Manchester (GM) teamed up with two independent organisations with expertise in public sector adaptation, Sniffer and Sustainability West Midlands, for a project that developed multiple resources, piloted two different training courses, consulted and engaged staff across multiple northern NHS organisations, and started building a business case for wider climate change adaptation in the NHS.

The outputs of this project are open-source and available on the SWM website or here on weadapt under the tag #NHSadapts and in the links below:

• A climate adaptation framework for NHS organisations in England
• An Adaptation Plan Template for NHS Trusts
• Guidance on including adaptation into your Green Plan
• Another tool, Adapt to Survive, has also been produced for NHS organisations to assess climate change risk and impacts and develop an adaptation plan during a previous project with Sustainability West Midlands in collaboration with the Environment Agency.

Project Aims

The three aims of this project overall were to:

1. Create some activities for increasing adaptation capability in the NHS
2. Develop some free, open-source tools any NHS organisation can use to help with their adaptation planning and capacity building
3. Plan for the future of adaptation capacity building in the NHS and ensure the legacy of the outcomes beyond the project’s lifetime

Dissemination Webinar

A webinar was held on 30 July 2024 to share the activities, resources, and learnings from the project. Watch a recording of this webinar here:

Key reflections

There are many indications that the health service in the UK is not prepared for a warming climate and the changes that come with this. The most recent UK Climate Change Risk Assessment, published in 2021, gave us a stark warning about the impact climate change is likely to have on our health, as have the World Health Organisation, the UK Health Alliance on Climate Change, and countless other public bodies, academic institutions, and, perhaps most importantly, the NHS and healthcare providers on the front line themselves already facing massive pressure:

“Some trusts are reporting record numbers of people coming in to A&E, with increased emergency admissions, often for respiratory problems and conditions made worse by dehydration. We have heard concerns about large numbers of people from care homes requiring treatment. This extra activity is leading to delays for patients requiring planned operations such as knee and hip replacements. The extreme heat has also highlighted the shortcomings of ageing buildings which are not designed or equipped to deal with these conditions.“

NHS Providers Deputy Chief Executive, Saffron Cordery

Below are some testimonials containing key reflections and takeaways from this project.

“Protecting the NHS from the impacts of climate change is a crucial focus in the UK today. The resources developed by SWM and Sniffer for this project are instrumental in guiding the NHS on its adaptation journey. Already, we are hearing discussions about integrating adaptation and resilience into the NHS, thanks to the senior leaders and other staff undertaking the ‘Becoming Climate Resilient’ training and awareness sessions.

We greatly welcome the collaborative approach taken by SWM and Sniffer. Their proactive stakeholder engagement at every stage, combined with their technical expertise, has resulted in outputs that are both relevant and accessible.”

Project partners Clare Macintosh, Regional Net Zero Programme Lead, NHSE North West and Claire Igoe, NHS Greater Manchester ICB

There are ambitious efforts being made to reduce our impact on the environment, including goals to become the world’s first net zero national health service. However, high demand and extreme weather events are not a thing of the future, but real issues affecting our frontline workers and our health now.

I was grateful for the opportunity to speak directly with various NHS staff across a range of Trusts and departments whilst facilitating the Becoming Climate Resilient training and our Task & Finish group. I was able to listen to real people with real exposure to this changing tide, experiencing an undeniable increase in heat and weather related demand that much of the public might not yet be feeling, an upwards trend that we are not prepared for.

My biggest reflection from this experience is how important it is to empower people with a feeling that they can, in fact, slow some of this tide. When we started, there was a sentiment that protecting and preparing for climate change was out of people’s remit or that driving change was too difficult. Even those who were already working on adaptation voiced that change was slow and hard.

Engagement needs to be at the heart of everything we do in this field. Only by sharing tangible examples of adaptation and providing a space for discussion and collaboration were we able to increase participants’ confidence in their ability to drive change.

Comment by Morgan Roberts, project lead for Sustainability West Midlands

Testimonials

“At Braford District Care NHS Foundation Trust we have a joint Climate Change Adaptation Plan with our neighbouring NHS Trusts but needed support to consider where to go next, how to achieve buy-in across the organisation and prioritise next steps. Getting involved in the Sniffer and SWM work made us realise we’re in the same boat as others and that because there are so many facets to Adaptation, we can learn from others who’ve made more progress elsewhere. The project enabled us to keep momentum with our Adaptation work and the Framework will be an invaluable addition to our Plan to help structure our activity over the coming years.”

Emma Clarke, Braford District Care NHS Foundation Trust and member of the Becoming Climate Resilient training cohort 1 and the Task & Finish Group

Activities for increasing adaptation capability in the NHS

One major purpose of this project was to create ways to engage NHS staff on the theme of adaptation, helping them understand the relevance of climate change to the NHS and build understanding on how to drive adaptation planning and action.

It was decided that two different online training sessions would be developed and piloted to achieve this purpose both during and beyond the life of the project: this resulted in ‘Becoming Climate Resilient’ training and an adaptation webinar for senior leaders.

The Becoming Climate Resilience training was created by adapting an existing Sniffer training course (“Becoming Climate Resilient”) to apply it to a healthcare context. Sniffer and SWM delivered this one-day, online course, to two cohorts of NHS staff (a total 28 participants) from a range of NHS organisations in the north of England. Feedback was collected in a survey afterwards and was overwhelmingly positive.

Senior Leaders recognised that senior leaders need both different information and a different approach to engagement than other NHS staff. Therefore, Sniffer and SWM also developed a session that was just one hour and a webinar to make best use of time, with a focus on policy, regulation, and driving effective adaptation as leaders. Three pilot sessions were delivered to a total of 46 participants.

Tools to help NHS organisations with adaptation planning and capacity building

Three main free, open-source resources were produced in this project:

• A draft Climate Adaptation Framework for NHS organisations in England (and a second document containing further guidance to supplement this)
• A downloadable Adaptation Plan Template for NHS Trusts
• A guide on how to include adaptation in your Green Plan and an overview of other regulatory reporting guidance on adaptation for the NHS

It was recognised that this work, especially the Climate Adaptation Framework, would be most effective if it included significant input from NHS staff directly. Therefore, as well as significant input from the three main NHS partners, an NHS Task & Finish Group was convened.

The Task & Finish Group consisted of around 12 individuals who opted to take part in this pilot after attending one of the ‘Becoming Climate Resilient’ training sessions. These were NHS staff working across a range of departments including Sustainability, Emergency Preparedness, Resilience and Response (EPRR), and Ambulance services.

Contributions were gathered through two workshops (one online and one in person) and written feedback of the resources as drafts were produced. Future plans and ideas were also discussed at these workshops for creating, using and disseminating the resource.

The Task & Finish group was an essential component to this project, as they were able to provide detailed knowledge on the context (such as current NHS governance, processes and regulations), ensure the right language was used for the sector, and consider what information and format they would find most practical if using the resources in their own role. This demonstrated the strong value of co-development and partnership working.

Ensuring the legacy of the project beyond its lifetime

It was important to all parties involved, and thus explicitly laid out in the plan for this project, that the legacy of the work produced was ensured. Two ways this was done were:

Hosting a business case development workshop between the main partners

This discussed how to develop the business case for adaptation, building a theory of change for adaptation in the NHS and using the Green Book’s five-case model as outlined in the Government’s business case guidance to start building the case for various potential adaptation activities in the future.

Uploading all the resources to weadapt

The project partners decided this was an ideal place to share all the outputs of this project, as a space online away from any particular partner’s own websites that ensures the legacy of the resources. The network on weadapt gives NHS organisations the ability to connect with others and share their own learnings going forwards despite this pilot coming to and end in July 2024.

For more information

Resources produced during this project are open-source and available on weadapt under the tag #NHSadapts and in the links below:

• A draft climate adaptation framework for NHS organisations in England
• An Adaptation Plan Template for NHS Trusts
• Guidance on including adaptation into your Green Plan and other NHS reporting
• Another tool, Adapt to Survive, has also been produced for NHS organisations to assess climate change risk and impacts and develop an adaptation plan during a previous project with Sustainability West Midlands in collaboration with the Environment Agency.

You can also contact Sniffer or SWM for more information on the project, reflections on particular activities, and the feedback provided by contributors, as well as how we can support you with your own climate change adaptation capability building and planning.