What would it take to climate-proof health and social care?

The title of the government’s 10 Year Health Plan, ‘Fit for the future’, raises an obvious question about the sort of future we will be living in a decade or more from now. Last month, an important report from the Climate Change Committee gave us some partial answers to that question.

Their report, A Well-Adapted UK, assesses how the UK’s climate is expected to change over the coming decades and how this could affect communities, public services, the economy, national security and other concerns. It provides a series of recommendations to ensure that as a country, we are better prepared for what is coming our way.  

The report warns that by 2050 the UK’s climate ‘will bring risks much more extreme than today’, with hotter, longer heatwaves ‘which may regularly exceed 40°C in parts of the country’ and with heightened flood risks due to more intense downpours and rising seas. The outlook for 2100 is harder to predict and depends on the success of global decarbonisation efforts but could involve ‘catastrophic damages’ to the UK. 

Recent years have given us a taste of what is to come. Since 2021, there have been at least 67 closures of NHS facilities as a result of flooding. During the peak of the 2022 summer heatwave, almost a fifth of UK hospitals had to cancel elective operations because of excessive temperatures. We are likely to see more of this very soon if the predicted ‘super’ El Niño generates extreme summer weather in 2026 and 2027. 

Looking at the impact on population health, there are currently around 2,000 excess deaths per year in the UK as a result of heat exposure. A Well-Adapted UK estimates this could rise to as high as 10,000 deaths per year by 2050. Over the same period, heat-related hospital admissions and attendances could triple compared to current levels. 

I find two things particularly striking in the report. The first is the implications for health inequalities. Climate change has consequences for us all, but it affects some more than others. Figures 1 and 2 illustrate how vulnerability to heat or flooding varies across the country. They shows that it is not the hottest areas that will suffer the most but the areas where people are less able to adapt to the impacts of climate change. This is because a person’s resilience depends on their health status, age, quality of housing and financial situation, as well as wider factors such as the strength of local social networks and access to public services. Similarly, Figure 3 shows that the most deprived neighbourhoods are significantly more vulnerable to the effects of climate change than wealthier areas.

The second thing that is notable in the report is the conclusion that some parts of the health and social care system are particularly unprepared for the health impacts of climate change. Specifically, the report singles out the dangers of high temperatures in care homes and argues that ensuring care homes can maintain safe temperatures for their residents should be a high priority. It warns that ‘there is little evidence that climate action is taking place [in the social care sector] and existing guidance does not always appear to be effectively disseminated down to working level staff’. 

What would it take for health and social care services to become more resilient so that people’s access to care is maintained in future? The short answer is about £0.7–£1.7 billion per year. That is the amount the Climate Change Committee estimates is needed to help climate-proof the sector. Most of this would be capital investment to adapt health care facilities, although the report highlights that other changes are needed including improved early warning systems to allow people and services to prepare for extreme weather, and targeted outreach to at-risk groups. While this would be a sizeable annual investment, the report’s modelling suggests that the savings generated through reduced mortality and morbidity could exceed the costs. 

Work on climate resilience by the UK Health Alliance on Climate Change argues that broader system changes may also be needed, including adding climate-related health risks to educational curricula for health professionals, taking greater account of these risks in urban planning, and investing in research to identify the most cost-effective climate adaptation strategies. Our own recent research highlights that to drive changes at the pace needed, climate objectives should be woven into routine NHS performance management processes, rather than being overseen through separate accountability arrangements. 

There are plenty of unknowns regarding climate adaptation. We don’t know how the global supply chains that the health and care sector depends on will be affected. We don’t know how broader issues such as food and energy security will affect the health of the nation (although A Well-Adapted UK assesses both of these risks). However, we do know that the UK is going to become significantly hotter and that flood risks will increase – that is now unavoidable. What matters is what we do next. If we want a health and care system that is truly ‘fit for the future’, that means taking action to protect people from the health impacts of climate change and ensuring that services can continue to function reliably despite the more extreme and more volatile conditions that lie ahead.