This resource was 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.
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Contents
Introduction
2
A climate adaptation framework for NHS organisations in England
How to use this framework
3
Understanding the Challenge
7
Organisational Culture and Resources
9
Planning & Implementation
11
Working Together
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Introduction The purpose of this guide 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 Adaptation Capability 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.
Case study: serious heat event, Summer 2022 • Temperatures reached over 40C for the first time in England and the UK
• 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. 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. Climate adaptation is any action to reduce vulnerability to the impacts of climate change. Understanding, anticipating, and adapting to these new challenges is essential to developing a more climate-resilient NHS. Additional information and guidance that sits alongside this resource can be found on WeAdapt.
• The Met Office issued the first ever red heat-health alert
• The UKHSA issued the first ever Level 4 alert, resulting in the government declaring a national emergency • Over 3,000 excess deaths in England over the summer period (over 65s particularly impacted)
Climate change has serious consequences for:
• Rail services were disrupted, Network Rail issued a ‘do not travel’ warning
• delivery of healthcare service: ranging from risks to the healthcare
• Power cuts occurred in Yorkshire, Lincolnshire and the North East
estate, the transport networks for accessing healthcare sites and to the resilience of supply chains which provide goods and services to support.
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How to use this framework Successful climate adaptation is not simply a case of analysing climate data and risk models. Effective leadership, governance arrangements, inclusive planning approaches and working beyond silos are all of equal importance for successful adaptation. 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 and become resilient to climate change, providing step by step tasks to guide the adaptation journey.
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.
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.
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.
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.
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Maturity stages Adaptation requires sustained, long-term commitment for an organisation – and adaptation capability will develop over time. The Framework includes maturity stages for each of the four capabilities:
Organisations will have different maturity levels 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.
To get the most out of this guide:
Look 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 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. Use the further guidance on the WeAdapt website that accompanies 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 highlighted throughout the framework to explore as well.
1. Starting
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. Pick & choose the tasks that seem most relevant to your organisation. Note: This resource includes a high-level description of the tasks, with further guidance and definitions on the WeAdapt website.
2. Intermediate
3. Advanced
4. Mature
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Starting
Intermediate (OC2)
Advanced (OC3)
Mature (OC4)
Understanding the Challenge
UC1A Learn about England’s changing climate UC1B Learn about climate impacts affecting health and healthcare UC1C Key staff undergo basic training on climate change risk and adaptation.
UC2A Develop understanding of climate risk and vulnerability UC2B Record the impact of recent weather events on your organisation UC2C Consider how your organisation’s functions might be affected by climate change
UC3A Integrate climate risk into corporate risk register UC3B Undertake detailed climate change risk assessment UC3C Identify knowledge gaps, seek expertise and foster links with research and innovation OC3A Identify opportunities to include adaptation and resilience in plans, policies and procedures OC3B Put governance arrangements for adaptation into operation OC3C Appoint named leads within service areas for specific adaptation actions or responsibilities OC3D Mainstream adaptation into your organisation’s plans, policies and procedures
UC4A Undertake project-level risk assessment UC4B Integrate climate adaptation into internal systems and procedures UC4C Actively engage in sharing, learning, research and innovation OC4A Establish communication and reporting processes for adaptation across service areas OC4B Review and update governance arrangements for adaptation
Organisational Culture and Resources
OC1A Consider how adaptation fits with your organisation and its objectives
OC2A Secure resources to plan and deliver adaptation
OC1B Identify resources available for adaptation
OC2B Engage with colleagues to identify adaptation opportunities across functions OC2C Establish governance arrangements for adaptation
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Starting
Intermediate (OC2)
Advanced (OC3)
Mature (OC4)
Planning and Implementation
PI1A Define a strategic vision for adaptation
PI2A Develop an initial adaptation strategy and action plan PI2B Take action to deliver initial adaptation PI2C Engage with relevant NHS internal structures and processes to plan for adaptation
PI3A Develop an appraisal process for selecting adaptation actions PI3B Develop a comprehensive adaptation action plan
PI4A Adopt an ongoing adaptive management cycle for adaptation planning PI4B Mainstream adaptation into your organisation’s functions PI4C Develop a strategic change process for adaptation outcomes
PI1B Identify a range of existing and potential adaptation actions PI1C Identify relevant NHS internal structures and requirements for adaptation
PI3C Implement a programme of adaptation actions
Working Together
WT1A Join and participate in relevant professional and/or adaptation networks WT1B Identify and engage a wide range of internal and external stakeholders
WT2A Develop key partnerships and opportunities
WT3A Formalise partnership working
WT4A Expand a programme of longer-term joint actions
WT2B Coordinate with partners to identify initial actions
WT3B Develop communication and engagement activities with partners
WT4B Take a lead in networks and peer organisations
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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.
Maturity Stage: Starting
Maturity Stage: Intermediate
UC1A Learn about England’s changing climate
UC2A Develop understanding of climate risk and vulnerability
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.
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.
UC1B Learn about climate impacts affecting health and healthcare
UC2B Record the impact of recent weather events on your organisation
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.
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.
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 and resilience.
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Maturity Stage: Mature
UC2C Consider how your organisation’s functions (or service areas) might be affected by climate change
UC4A Undertake project-level risk assessment
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. Maturity Stage: Advanced
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.
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.
UC4B Integrate climate adaptation 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.
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.
UC4C Actively engage 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). Research and innovation can be harnessed to co-produce adaptation solutions, alongside local stakeholders.
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 at system level or connect with research and innovation.
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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 priorities. Over time, adaptation will become mainstreamed into plans, policies and procedures – part of business as usual for your organisation.
Maturity Stage: Starting
Maturity Stage: Intermediate
OC1A Consider how adaptation fits with your organisation and its objectives
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.
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.
OC1B Identify resources available for adaptation
OC2B Engage with colleagues to identify adaptation opportunities across functions
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.
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.
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OC2C Establish governance arrangements for adaptation
OC3D: Mainstream adaptation into your organisation’s plans, policies and procedures
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 works for your organisation and can deliver your adaptation objectives. This could be a new group or expanding an existing Board’s remit. Maturity Stage: Advanced
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. Maturity Stage: Mature
OC3A: Identify opportunities to include adaptation and resilience in plans, policies and procedures
OC4A: Establish communication and reporting processes for adaptation across functions/service areas
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 .
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 a governance group.
OC3B: Put governance arrangements for adaptation into operation
Governance group is established with appropriate authority to approve and implement change. If required, governance group receives appropriate training on climate risk, adaptation, and resilience to empower decision making.
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.
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.
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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.
Maturity Stage: Starting
PI1A Define a strategic vision and outcomes for adaptation
PI1C Identify relevant NHS internal structures and requirements for adaptation
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. Maturity Stage: Intermediate
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.
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. 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.
PI2A Develop an initial adaptation strategy and action plan
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.
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PI2B Take action to deliver initial adaptation
PI3B Develop a comprehensive adaptation strategy and action plan
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.
A comprehensive adaptation strategy and action plan draws together knowledge of climate risk and appraised adaptation options (Task 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.
PI2C Engage with relevant NHS internal structures and processes to plan for adaptation
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 (e.g., estates, ops, community resilience). Ensure this information feeds into your adaptation action plan (see PI2B). Maturity Stage: Advanced
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.
PI3A Develop an appraisal process for selecting adaptation actions
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.
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Maturity Stage: Mature
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 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.
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.
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’, logic models, or ‘theory of change’ you can explore a range of possible options over time – and the potential role of your organisation.
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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 a diverse range of stakeholders to help shape your adaptation plans.
Maturity Stage: Starting
Maturity Stage: Intermediate
WT1A Join and participate in relevant professional and/or adaptation networks
WT2A Develop key partnerships and opportunities
In the groups and networks you have identified (WT1B), speak with people about on-going 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. Be sure to continue sharing best practice and learn from each other’s successes and challenges.
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 informally, such as the WeAdapt platform.
WT1B Identify and engage a wide range of internal and external stakeholders
WT2B Coordinate with partners to identify initial actions
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 coordination of on-going work such as including partners in some of your own smaller adaptation actions or vice versa can build momentum.
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, and therefore should be considered in your adaptation work. Look beyond the ‘usual suspects’. Authentic engagement will allow for adjustment of your plans and an opportunity for you to influence others.
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Maturity Stage: Advanced
Maturity Stage: Mature
WT3A Formalise partnership working
WT4A Expand a programme of longer-term joint actions
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.
As you work with partners more frequently and on larger projects, you will need to formalise partnership arrangements – agreeing roles, responsibilities and funding allocations. This might build upon existing arrangements or might need you to establish a new partnership.
WT3B Develop communication and engagement activities with partners
WT4B Take a lead in networks and peer organisations
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.
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.
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This resource has been designed for NHS organisations in England. Much of the advice could, however, be applicable to healthcare providers throughout the UK and beyond. Don’t forget to visit the WeAdapt website, for more information on climate change and its impacts, further guidance for the tasks in this Framework, and a wealth of other open-source resources around adaptation alongside a space for collaboration. We hope this resource, along with the rest of the resources available, helps you to reflect, plan, and act, becoming more prepared for effectively adapting to a changing climate and a contributing to a more resilient healthcare system as a result.
To address the complexity of the change process required by large organisations to prepare for, and 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 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 as a result of this project with support from a dedicated Task & Finish Group of NHS colleagues. The draft 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.
www.weadapt.org/tags/nhsadapts/
www.sniffer.org.uk/
www.swm.org.uk/consultancy/climate-change-adaptation-support/
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This resource 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 noncommercial 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 ”
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