This guidance sits alongside 'A climate adaptation framework for NHS organisations'. These resources were produced as part of a pilot project, commissioned by NHSE North West, NHSE North East & Yorkshire, and NHS Greater Manchester, to support NHS organisations adapt to climate change. The project was delivered by Sniffer and Sustainability West Midlands, with support from a dedicated Task & Finish Group of NHS colleagues. August 2024.
Climate Adaptation Framework for NHS organisations – Further Guidance
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
Further guidance for the climate adaptation framework for NHS organisations in England
Introduction A 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. This resource has been produced by Sniffer and Sustainability West Midlands (SWM) as a result of a pilot project in partnership with NHSE North West, NHSE North East & Yorkshire, and NHS Greater Manchester, with support from a dedicated Task & Finish Group of NHS colleagues. Other activities in this project (which can all be found on the weADAPT website under the tag #NHSadapts) resulted in the following outputs:
• An Adaptation Plan Template for NHS Trusts • Guidance on including adaptation into your Green Plan • Becoming Climate Resilient training • Climate Adaptation for NHS Senior Leaders training
The framework also makes reference throughout to recently published Adapt to Survive, a risk assessment and adaptation planning toolkit for healthcare providers, developed by Sustainability West Midlands. For context on what the risks are to health and healthcare from climate change, see our glossary at the end of this document.
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
The Four Adaptation Capabilities 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 Graphic showing the four capabilities in the Climate Adaptation Framework: Understanding the Challenge, Organisational Culture & Resources, Planning & Implementation, and Working Together.
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.
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
To get the most out of the resource There is a downloadable PDF booklet that covers 43 recommended tasks contained across maturity stages in each capability. The booklet can be found here, and includes a high-level description of each task to provide a concise summary of the framework. This document includes further explanation, guidance, and extra relevant links for each task. 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 this document 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, and key definitions on climate change, the risks, and adaptation tailored towards a healthcare audience can be found at the bottom of this document.
Further Guidance on 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.
Our Climate Adaptation Framework includes 12 tasks across the four maturity levels to support your capability around Understanding the Challenge:
2 Table of the 12 tasks across the four maturity levels for the capability ‘Understanding the Challenge’. You can read these 12 tasks below.
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
Starting Maturity Tasks UC1A: Learn about England’s changing climate
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.
Further guidance:
• Visit the UK Climate Projections website or The Met Office climate data portal to explore information about future projected changes in climate.
o Identify relevant climate projections, and reflect on how your organisation could be affected by changes at the local, national and global levels
• Take a look at Adapt to Survive, a resource which provides useful information on key considerations and guidance on using these, and other resources, to explore national and local projected changes.
UC1B: Learn about climate impacts affecting health and healthcare
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. Learning about the impacts on the health system will help you understand current and potential implications for your organisation.
Further guidance:
• Read the Health and Social Care Sector Briefing – UK Climate Risk
• Review Climate change: health effects in the UK and stay up to date on latest UKHSA evidence
• Review the third National Adaptation Plan
• Adapt to Survive provides useful summary information on key consideration for NHS organisations, as well as guidance on using external resources to explore the impacts that climate change can have in your area. UC1C: Key staff undergo basic training on climate change risk and adaptation. In order 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 the approaches to adapting.
Further guidance:
• Key staff (as identified in OC1B see organisational culture) should undergo basic training on climate change risk and adaptation. Training could take many forms including ESR, Met Office training, Carbon Literacy, Flood Literacy, Becoming Climate Resilient training, Senior leader workshops, eLearning as well as less formal learning opportunities such as sharing the information condensed into this or other resources.
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
• Identify opportunities to include adaptation in staff training and/or inductions to raise adaptation awareness and build capacity. Find out how climate change and adaptation is currently covered in staff inductions and training and identify opportunities for new resources and training to be included.
Intermediate Maturity Tasks UC2A Develop understanding of climate risk and vulnerability
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.
Further guidance:
• Climate change will disproportionately affect disadvantaged communities. Learn about climate justice and consider how your organisation should respond: Who is vulnerable? | Climate Just
• Use the Local Climate Adaptation Tool (lcat.uk) to identify the climate and social
vulnerability trends affecting the area(s) where your organisation operates. You may also want to use the SHAPE – Shape (shapeatlas.net) tool to support mapping vulnerabilities. Local health data may also be used to help inform your understanding of local vulnerabilities.
UC2B Record the impact of recent weather events on your organisation
Your organisation will 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.
Further guidance:
• Collate evidence on how the severe weather event(s) that you identified have impacted your organisation. Potential sources of information could come from areas such as your EPRR colleagues and could include: o overheating and flooding data submitted to Estate Returns Information Collection (ERIC) reporting
o SWEP (Severe Weather Emergency Protocol) records,
Insurance Claims Logs
o
Repair and maintenance reports
o
o engagement with Local Resilience Forums (LRFs)
o Anecdotal events flagged up through interviews and workshops held with colleagues ( UC2B ).
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
• If you are struggling to find information within your own team on severe weather events, you can request historic information on flooding from the Environment Agency: Find out if your property is in an area that has flooded. The Met Office also have a section on their website on past weather events: Past weather events – Met Office • Produce case studies and/or a short report describing the impacts and costs of severe weather events that have affected your organisation. Include a description of how and why these impacts and costs may be affected by projected changes in climate. Your local authority may have a Local Climate Impact Profile which could be used to support your report. UC2C Consider how your organisation’s functions or service areas might be affected by climate change Your organisation will have many functions that might be affected by climate change. To identify these you will need to engage with a diverse range of internal stakeholders to explore the connection between strategic and operational priorities and climate impacts.
Further guidance:
• Use the Adapt to Survive worksheet template (Tabs 3a and 3b) to consider how climate change might affect the functions listed in the NHS Business Impact Analysis Template • Interview a small number of key service managers or contacts in your organisation to identify links between the strategic and operational priorities of different services or functions and climate impacts. The interview will help identify how services are affected by current weather and climate impacts. Consider which critical functions appear most vulnerable to climate impacts. Alternatively you could hold a Climate Impact Assessment workshop with representatives from different departments/ services to share experience of the ways that climate impacts have affected your organisation.
Advanced Maturity Tasks UC3A Integrate climate risk into corporate risk register
Use your organisation’s risk registers (at corporate or service level) as a way to heighten awareness, consideration and action on climate adaptation.
Further guidance:
• Work with your organisation’s Risk Manager to define and embed climate risk within your risk register. • See whether any other organisations you work with (NHS or otherwise) have included climate risks within their risk register that you can learn from.
UC3B Undertake detailed climate change risk assessment
A climate change risk assessment is used to evaluate climate risks across your estates, infrastructure and operational services/ functions. 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.
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
Further guidance:
• Complete the NHSE Climate Change Risk Assessment (a tool currently under development) to capture risk descriptions, consequences and existing controls or plans in place to help address the risks or opportunities. • Until this tool is published, other risk assessment tools include the NHS general risk assessment framework, the EPRR core standards, and Adapt to Survive.
UC3C Identify knowledge gaps, seek expertise and foster links with research and innovation
As work on adaptation advances, you should 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 or connect with research and innovation.
Further guidance:
• Share knowledge gaps and research needs with partner organisations ( WT1A see Working Together), including other NHS organisations, to help identify any relevant existing research or shared research priorities. • Search for relevant research and technical experts who could address the knowledge gaps that you have identified. Identify whether there are any academics who may be interested in collaborating with your organisation to develop research projects, potentially enabling your organisation to benefit from research council funding.
Mature Maturity Tasks UC4A Undertake project-level risk assessment
Conduct a project-level 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/assets. The project-level scope allows for an appropriately detailed analysis of climate risks and identifies opportunities to embed adaptation into projects from their inception.
Further guidance:
• The templates on this webpage are suitable for project level risk assessment in built environment and infrastructure projects: Adaptation Scotland :: Climate Change Risk Assessment Guidance & Tools • See this case study of a project-level risk assessment: Climate Northern Ireland – Omagh Enhanced Local Hospital
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
UC4B Climate adaptation is integrated into internal systems and procedures Integrate knowledge into internal systems, responsibilities and procedures, so that adaptation is no longer seen as an ‘add-on’ task or something that is someone else’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.
Further guidance:
• Ensure that climate risk is included during Sustainability Impact Assessments for new projects. • To improve organisational awareness of climate change risk and adaptation, training could be rolled out further across teams, building on Task UC1C . Training could take many forms including ESR, Met Office training, Carbon Literacy, Flood Literacy, Becoming Climate Resilient training, Senior leader workshops, eLearning as well as less formal learning opportunities. • As Named Leads become formalized across functions, ensuring integration of adaptation responsibilities into job descriptions will help ensure robust resourcing.
UC4C Actively engaged in sharing, learning, research and innovation
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 see working together). Research and innovation can be harnessed to co-produce adaptation solutions, alongside local stakeholders.
Further Guidance on 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.
Our Climate Adaptation Framework includes 11 tasks across the four maturity levels to support your capability around organisation culture and resources:
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
3 Table of the 11 tasks across the four maturity levels for the capability ‘Organisational Culture and Resources’. You can read these 11 tasks below.
Starting Maturity Tasks OC1A: Consider how adaptation fits with your organisation and its objectives Identify how adaptation impacts delivery of your organisation’s strategic objectives. You will need to consider where adaptation is best placed in your organisation and start to identify relevant groups and decision-making processes that will need to consider adaptation.
Further guidance
• Identify your strategic priorities, organisational objectives or outcomes and consider how these could be affected by and/ or contribute towards adaptation. For example, your organisation will have priorities related to improving local health outcomes. This links to climate change adaptation as people and communities experiencing multiple causes of vulnerability are often most vulnerable to the impacts of climate change. • Use the insights gained through completing Tasks UC1A & UC1B (see Understanding the Challenge) to support communication on why adaptation matters. • Consider what motivates or may motivate your organisation to adapt to climate change (damage costs avoided, ensuring continuity of service). Explore what risk management approaches to managing weather and climate related risks already exist and reflect on the risk appetite of your organisation.
OC1B Identify resources available for adaptation
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 within your organisation that will enable you to plan and deliver future work.
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
Further guidance:
Consider the following six types of resources:
Human resources
•
o Identify job roles, teams, committees or individuals that may already be developing policies, plans, or actions aligned with adaptation or who have knowledge of climate change issues and duties. o Who will develop and deliver your adaptation arrangements internally? For example, Emergency Preparedness, Resilience and Response (EPRR) colleagues, and Estates and Sustainability teams who may be working towards your Green Plan objectives. o Who will help you plan and deliver your adaptation work? Do you have a Sustainability/Climate Working Group or Corporate Management Team which meets regularly? Governance arrangements are further explored in Task OC2C.
Physical and material resources
•
o Understand the different types of assets and what their roles in adaptation might be. o Identify any assets that your organisation owns or manages that support resilience and adaptation (for example flood resilience infrastructure or estates and greenspaces that provide ecosystem services).
Financial resources
•
o Examine what funding is currently allocated to support work aligned with adaptation and what funding opportunities exist.
Intellectual resources
•
o Catalogue the skills that your organisation has access to that could help with adaptation work (for example risk managers, engineers, GIS and data analysts, community engagement, resilience practitioners, communication or environment specialists and those with facilitation skills). See Task OC2A regarding assigning resource.
Information resources
•
o Determine what adaptation information (including records of climate impacts) your organisation currently promotes internally and/or externally and identify who holds theses resources.
Monitoring resources
•
o Understand what resources (staff, processes, metrics/indicators) the organisation has for monitoring, evaluating and reporting.
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
Intermediate Maturity Tasks OC2A: Secure resources to plan and deliver adaptation
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, wellbeing.
Further guidance:
• Increase your understanding of internal budget and investment cycles
o Identify lead in times and business cases requirements for annual and multi annual budget allocations.
o Clearly define the short term adaptation activities that require resourcing.
• Estimate the resources (for example staff time, funding, access to technical expertise) required to deliver the activity. o Identify whether there are existing resources ( OC1B ) that could be allocated to deliver some or all of the activity, where there is a resource gap identify a budget holder/ funder who may be able to resource the activity and find out about the procedure for submitting a budget request. • Build a business case to resource the activity. The business case for these types of activities is usually built around a clear strategic case linked to organisational priorities ( OC1A ) and/or legislative requirements ( PI1C see Planning and Implementation). You can access guidance on developing a Business Case here:
o NHS England: General business case process guidance
o The Green Book: appraisal and evaluation in central government
• Identify opportunities to share resources, benefit from in-kind support and reduce duplication of effort. Find out if partner organisations – including other NHS organisations ( WT2A see Working Together) – are planning to carry out similar adaptation activities and explore opportunities to share resources such as data, technical expertise or staff time. • For further guidance on Funding Options, see guidance in Adapt to Survive – Sustainability West Midlands OC2B: Engage with colleagues to identify adaptation opportunities across functions Your organisation will (or could) be delivering adaptation 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.
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
Further guidance:
• Identify opportunities to progress adaptation with people, functions and projects. Use the knowledge gained from OC1A to identify immediate opportunities to engage and influence adaptation work across functions. • Use formal and informal meetings, events and workshops to talk about adaptation and communicate the need for and benefits of adaptation for your organisation. This includes everything from informal one to one discussions through to more formal presentations and awareness raising workshops. The Adapt to Survive resource includes useful background information which could be used to inform presentations or workshops. • Identify opportunities to include adaptation in staff training and/or inductions to raise adaptation awareness and build capacity. Find out how climate change and adaptation is currently covered in staff inductions and training and identify opportunities for new resources/ training to be included.
OC2C: Establish governance arrangements for adaptation
Setting up governance arrangements for adaptation is essential to enable effective decision- making and collaborative delivery across your organisation. Seek approval for an option that works for your organisation – and is able to deliver your adaptation objectives. This could be a new group, or expanding an existing Board’s remit to include adaptation. Good governance will provide oversight for a work programme and define roles and responsibilities for function leads.
Further guidance:
• Identify where adaptation leadership and governance currently sit within your organisation. Identify the role and remit of any groups with responsibility for adaptation, for example Business Continuity or EPRR teams. • Identify whether new/ additional governance arrangements are required to increase progress with adaptation. • Create a short report/ briefing setting out options for governance arrangements and seek agreement to implement the preferred option.
• Where a new group is to be established:
o Develop draft terms of reference that will be finalised once group members have been confirmed, Identify a chair for the group, Create a list of potential participants and issue invitations to join the group
• Where adaptation is to be added to the remit of an existing group:
o Agree alternations to the existing terms of reference to include adaptation, Review membership of the group to identify whether the group includes sufficient knowledge/ influence over adaptation. Request additional group members if representation / knowledge of adaptation needs to be strengthened.
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
Advanced Maturity Tasks OC3A: Identify opportunities to include adaptation and resilience in plans, policies and procedures 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, but also look beyond the ‘obvious’ to areas that may not have considered climate adaptation.
Further guidance:
• Identify opportunities to include adaptation in various organisational plans, policies and/or procedures. Consider policy and planning timescales and identify windows of opportunity. e.g 10 year ICS Estates Infrastructure Plan • Take advantage of opportunities such as consultation on new or review of pre-existing policies and strategies to submit comments on how adaptation could be included or incorporated. • Create a list of upcoming policy and strategy review opportunities and allocate time to providing consultation responses/ feedback on those with greatest potential to influence adaptation. • Speak with colleagues about incorporating adaptation into existing processes which can be used to screen new policies, plans, strategies and projects for climate-related threats and opportunities.
• Ensure adaptation is included in all sustainability impact assessments completed.
OC3B: Put governance arrangements for adaptation into operation
Establish a governance group with appropriate authority to approve and implement change. If required, a governance group should receive appropriate training on climate risk, adaptation, and resilience to empower decision making.
Further guidance:
Create a work programme
•
o Develop a work programme for the group that aligns with your organisational priorities and adaptation aims. o Organise meetings of the governance group (or the wider group in which your adaptation work will be governed – including named leads) o Ensure the governance group has oversight and organisational sign-off of adaptation activities.
• Ensure resources committed to adaptation.
o Examine your short, medium and long-term adaptation needs ( PI1B see Planning and Implementation). Estimate potential resources required and build a business case that aims to secure initial resources ( OC2A ).
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
• Make sure there is ownership of actions.
o Ensure there are diverse members of the governance group including those with sufficient authority and power o Delegate actions to specific members of the group or named leads within functions.
OC3C: Appoint named leads within functions for specific adaptation actions or responsibilities. To embed adaptation across the organisation, seek to formalise adaptation roles and responsibilities taken by different functions, with named leads in place.
Further guidance:
• Contact potential named leads as identified in OC2B and ask them to commit to the role within their service area or function. This could include named leads in Clinical, Estates, Fleet, Sustainability teams, for example. • Identify specific roles for adaptation leads across functions. This process should have oversight from Governance group as set up in OC2C . This could range from supporting awareness raising through to delivery of actions within projects and departments.
OC3D: Mainstream adaptation into your organisation’s plans, policies and procedures You can reduce reliance on stand-alone adaptation actions (often 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.
Further guidance:
• Link adaptation work to your organisational outcomes
o Demonstrate the importance of adaptation to the overall organisation by showing how existing adaptation work contributes to achieving organisational objectives. o Demonstrate how planned adaptation work will support progress towards organisational outcomes; provide evidence of social, economic and environmental benefits. • Consider how internal policies or legislation may further enable adaptation. Be aware of internal timescales and identify opportunities to incorporate adaptation into the creation of new or revision of existing policies.
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
• Some relevant existing national and NHS policies to consider in both points above are listed in Adapt to Survive
Mature Maturity Tasks OC4A: Establish communication and reporting processes for adaptation across functions/service areas 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 arrangement you have in place has a role to maintain co-
ordination and oversight across adaptation actions. This includes a mechanism for communication between service area named leads and the governance group.
Further guidance:
• Maintain regular contact with function leads offer support if needed.
o Check in with named leads to understand current progress and identify any challenges they may be facing.
o Request input from all leads on the actions they have undertaken to be fed into Green Plan reporting (at least during the annual requirement for reporting period). • Promote the communication and profile raising of adaptation aims, objectives and progress by providing updates on adaptation work as part of committee papers or senior management team briefings. Engage with senior leaders on adaptation and maintain profile raising:
o Regularly brief new and emerging leaders on adaptation progress and priorities.
o Encourage leaders to speak about adaptation at related events where possible.
o Have comms around adaptation and resilience prepared to share with senior leaders at pivotal moments such as extreme weather events (after a flood or heatwave).
OC4B: Review and update governance arrangements for adaptation
Your organisation 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 taking place in your organisation.
Further guidance:
• Identify new opportunities and priorities areas for future work
o Work with the governance group to identify any new or emerging opportunities to enact adaptation work. It is important that within your organisation adaptation efforts are prioritised, recognising their contribution to wider organisational goals, and ensuring that adaptation work is appropriately resourced.
• Regularly reflect on and review governance arrangements
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
o Look back on progress, successes and challenges that you have had over the course of your adaptation work so far. Consider what could be improved and solutions or changes to alter current working. Periodically review procedures, activities and governance structures for adaptation to determine effectiveness. o Support periodic use of the Adaptation Framework for self-assessment of adaptation progress o Be flexible. The governance arrangements identified and agreed in OC2C may no longer be appropriate or relevant. Be prepared to alter arrangements to best fit your ways of working and adaptation action. This may involve less project governance and a transition to higher-level strategic governance. Further Guidance on 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.
Our Climate Adaptation Framework includes 12 tasks across the four maturity levels to support your capability around Planning & Implementation:
4 All 12 tasks for the Planning & Implementation Capability. You can read these 12 tasks below.
Starting Maturity Tasks PI1A Define a strategic vision and outcomes for adaptation
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.
Further guidance:
• Develop a ‘climate ready’ vision for your organisation to provide focus for ongoing adaptation activities.
• Define clear adaptation goals, objectives or outcomes.
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
o Develop adaptation aims, outcomes and/ or a vision that clearly communicates what your organisation is aiming to achieve. o Make sure that any goals are measurable so that data can be captured over the implementation of the adaptation work. o Assess and highlight how your adaptation aims and objectives contribute to or enhance other corporate responsibilities and priorities ( OC1A ), such as tackling inequalities and achieving better health outcomes.
PI1B Identify a range of existing and potential adaptation actions
Your organisation will already be taking actions that deliver adaptation, even if they are not always recognised as such. 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 that your organisation could take – either alone or with partners. It is important to consider a wide range of actions, both short- and long-term, easy and difficult.
Further guidance:
• Identify work that is already occurring within your organisation to progress adaptation or build capacity to adapt. These activities may not be formerly called or recognised as adaptation. o Review the on-going activities, plans or policies within various different services or departments of your organisation and consider how they may support climate adaptation. For example your Estates team may be considering climate adaptation in the form of ensuring buildings are able to deal with flooding, resist severe storms and cope with overheating. • There is an overview of the different types of adaptation actions in the glossary on this website. For a list of potential adaptation techniques and guidance on choosing those most relevant to your organisation, see Adapt to Survive: a suite of resources for adaptation planning. PI1C Identify relevant NHS internal structures and requirements for adaptation Planning adaptation will require you to interact with stakeholders from across the NHS. Map out NHS structures and how you fit into these. Start conversations about adaptation with existing NHS networks and structures and identify new ways to engage with internal structures and contacts to drive adaptation. Ensure a diversity of stakeholders. Engaging across multiple services enables you to understand potential conflicts of interest, identify where actions have benefits for multiple services and helps to avoid taking actions with negative side-effects.
Further guidance:
• Read Adapt to Survive to help understand drivers for adaptation within NHS, including internal and external requirements such as the National Adaptation Programme, Adaptation Reporting Power, TCFD-aligned disclosure, and the EPRR Core Standards.
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
• Assess what is happening already on adaptation within your local health system and identify who you need to engage with. For example, as an ICB you can map out service providers across your ICS. All organisations should investigate whether a map of adaptation activities and responsibilities within your local health system has already been completed. When identifying who you will be engaging with, consider the following questions: • Map out and understand the strategic requirements/expectations/goals around adaptation outside your trust that impact you, including within the NHS and England more broadly. There may be minimal specific guidance in England on Adaptation and Adaptation Planning, but there are strategies within the NHS and beyond that are relevant to be aware of and can have adaptation applied to.
Intermediate Maturity Tasks PI2A Develop an initial adaptation strategy and action plan
Develop 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.
Suggested tasks:
• Define the scope of the initial adaptation strategy/action plan.
• Start to set out an understanding of roles and responsibilities for different areas of adaptation between these structures (e.g., estates, ops, community resilience) (Task OC2B see Organisational Culture). • Communicate the case for adaptation – the initial adaptation strategy/ plan is an important engagement and awareness raising document. Include key facts about climate trends, projections and impacts for your organisation ( UC1A, UC1B, UC2B see understanding the challenge). Explain how adaptation will benefit your organisation including any links to wider organisational strategic priorities and outcomes ( OC1A see Organisational Culture). • Looking at the actions you have listed ( PI1B ), you could start to prioritise these actions based on the potential severity of the impacts as well as how prepared you are for the hazards they address already. An action plan should include at the very least specific quick wins, who is responsible for these and how the actions will be delivered. You should also have a programme of delivery established for some longer-term actions and start assigning resource to these. For further guidance, see Adapt to Survive.
PI2B Take action to deliver initial adaptation measures
Take early practical action on adaptation by building upon existing projects or implementing no- regret / quick-wins actions. These help raise the profile of adaptation, building internal support and helping to spur further action.
Further guidance:
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
• Assign named leads (Task OC3C see Organisational Culture) for adaptation actions within your action plan. • Report progress with implementing actions on a regular basis. This will allow you to communicate successes and highlight barriers to implementation. • Build support and awareness of the benefits of adaptation actions by communicating successful implementation of actions. This helps build on the success of implementing actions to explore opportunities for further, more ambitious actions. PI2C Engage with relevant NHS internal structures and processes to plan for adaptation Have an engagement plan for engaging with other areas of the NHS. Start to set out an understanding of roles and responsibilities for different areas of adaptation between these structures (e.g., estates, ops, community resilience). Ensure this information feeds into your adaptation action plan (see PI2B).
Advanced Maturity Tasks PI3A Appraisal of adaptation options
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.
Further guidance:
• If appropriate, use decision support tools, such as:
Economic appraisals
o
Cost benefit analysis
o
Cost effectiveness analysis
o
o Multi criteria decision analysis (could include co-benefits, efficacy, feasibility, resource availability, timing/urgency, climate justice)
Adaptation pathways assessment
o
• Record your decision making process in a transparent fashion so that governance group and decision makers can assess the structured appraisal for each of the options in relation to selected criteria and why actions have been prioritised over the short, medium and long term.
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
PI3B Develop a comprehensive adaptation strategy and action plan
A comprehensive adaptation strategy and action plan draws together knowledge of climate risk and appraised adaptation options ( PI3A ) – to translate your strategic objectives into practical action. It should coordinate and integrate adaptation into relevant projects, policies and plans across your organisation and with partners.
Further guidance:
• Ensure each action has clear ownership, targets, measures of success and timelines for implementation and completion as well as relevant milestones. • Have a formalised process for regular communication, planning and delivery such as an adaptation board ( OC3B see Organisational Culture), both within your organisation and across the NHS when carrying out system-wide adaptation planning. • Seek approval or endorsement from your organisation and buy in from all departments or individuals assigned any actions. • Use the publication of the final action plan/strategy to build further awareness and support for implementation. Infographics can be used to clearly communicate key facts and messages contained within the strategy/ plan. A briefing for senior leaders will also be important. Discuss publication of the strategy/ plan with your organisations press/communication team and develop a press release.
PI3C Implement a programme of adaptation actions
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 (see PI4A ). Mature Maturity Tasks PI4A Adopt an ongoing adaptive management cycle for adaptation planning 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 is well suited to climate adaptation. Adaptation will always be an iterative process rather than a destination as needs and challenges change. Understanding your position within the wider NHS system will be integral to this .
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
Climate Adaptation Framework for NHS organisations – Further Guidance
Further guidance:
• Periodically assess your maturity across capabilities using the Climate Adaptation Framework. Reflect on these results to identify areas of weakness which may need further support.
• Other tips for reviewing and assessing your performance on adaptation actions:
o Work with colleagues across your organisation to understand and capture outcomes of ongoing work which contribute to adaptation. o Through reviewing implementation of adaptation actions you should be able to learn what is suitable and what is less appropriate for your identified climate challenges and opportunities. o Revisit your aims, objectives and risks and how these are being achieved by planned work. o Questions to consider: How well was the action implemented? Was it delivered on time and on budget? Have the anticipated benefits of the action been realised? What additional benefits has the action delivered? • Here is a short 2-pager introduction to the PDSA cycle, and you can use the NHS Handbook of Quality and Service Improvement chapter 5.2 for further guidance on applying this to your planning and evaluation processes. Also consider this module in the NHS Improvement Leaders’ Guide. PI4B Taking action on adaptation is mainstreamed into your organisation’s functions For adaptation to become routine, it needs to be mainstreamed into the business-as-usual activities and KPIs 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.
Further guidance:
• Work with colleagues to ensure business procedures include consideration of climate change risks early in the development of new projects e.g. via Sustainability Impact Assessment processes. • Include management of climate risks or the ability to adapt in specification or business cases for major asset or infrastructure projects. PI4C Develop a strategic change process for achieving adaptation outcomes 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’ or ‘theory of change’ you can explore a range of possible options over time – and the potential role of your organisation.
Authors: Sustainability West Midlands; Sniffer Partners: NHSE North East & Yorkshire, NHSE North West, NHS Greater Manchester
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