As the NHS is reformed, six things can’t afford to be overlooked

It’s been a big month for the National Health Service. Two weeks ago, the government announced plans to abolish NHS England, the non-departmental public body that oversees the work of nearly 7,000 NHS organisations across England. Over the next two years, its functions will be brought under the control of ministers at the Department of Health and Social Care (DHSC), in a bid to “reduce bureaucracy, make savings and empower NHS staff to deliver better care for patients.”

It’s a noble aim. We just hope that NHS England’s latest ‘Health and climate adaptation report’ will be considered in the transition.

That report – written in conjunction with the UK Health Security Agency (UKHSA) – offers an unequivocal warning: “Climate change threatens the health of the population and the ability of the NHS to deliver its essential services in both the near and longer term.”

It adds that “While the groundwork has been laid, further work needs to be done to ensure healthcare systems, facilities, and supply chains can withstand future climate pressures.”

What that work looks like is largely still to be seen. Right now, the report notes, the healthcare sector is moving into “the implementation phase” of climate adaptation, and the effectiveness, feasibility, and cost-benefits of various interventions still need to be assessed.

Having read the report, we just hope the government will consider the following, when setting budgets and priorities for the NHS, in years to come:
 

1) Hospital temperatures – “Provisional data shows a 53% rise in overheating incidents triggering a risk assessment [on the NHS Estate] from 2016/17 to 2023/24.” Such incidents threaten the health of patients and healthcare workers. Without adaptation, as periods of extreme heat in England become more frequent, they’re only likely to become more common. 

Our hope: the government remains committed to retrofitting NHS England’s 16,000 buildings (where needed), to ensure they stay at safe temperatures during future heatwaves.
 

2) Overheating pensioners – with limited global decarbonisation and no additional adaptation, extreme heat could be responsible for 10,889 UK deaths per year in the 2050s – a figure roughly equivalent to the population of a small town. That’s according to a UKHSA report released at the end of 2023. It’s likely most deaths would occur in the community (outside of hospital settings) and the elderly (among other groups) are particularly vulnerable to heat-related illnesses (like heatstroke). 

Our hope: the government will support the development of new technologies – like U.S. startup Eztia’s cooling wearable patches – which could help to reduce the risk for vulnerable populations.
 

3) Flooded facilities – “flood incidents, monitored since 2020/21, have increased by 103% [on the NHS Estate], rising steadily from 176 to 358 occurrences by 2023/24.” When such floods occur, they risk significantly affecting the Health Services’ ability to function.

Our hope: the government fully supports efforts to minimise flooding’s impact on patient care. (The report points out that digital healthcare services could help maintain service continuity when extreme weather events – like floods – render facilities inaccessible. There are no doubt other methods.)
 

4) Resilient IT systems – during an unprecedented heatwave in July 2022, temperatures reached 40°C in London. When they did, “cooling systems failed at 2 data centres supporting London’s largest NHS trust.” Whilst operations temporarily became paper-based, “service delivery dropped significantly” at Guy’s, St Thomas’ and Evelina London hospitals, with “referrals at 64%, outpatient appointments at 84%, elective surgeries at 71% and diagnostic tests at 68% of typical July levels.” The problem wasn’t an overnight fix: “Emergency IT systems were restored in 5 days, with full recovery extending over several weeks and incurring £1.4m in additional costs.”

Our hope: the government dedicates adequate funding to climate-proofing IT systems in all of the 215 NHS trusts across England.
 

5) Vulnerable groups – the report notes that, without targeted adaptation measures, “climate change is likely to exacerbate existing health inequalities.” Climate change will disproportionately affect “populations who have limited control over their environments, fewer resources to adapt their behaviours, and less capacity to respond to new threats.” Those most at risk include:

• Older adults

• Those with a physical or mental health condition

• Children

• Individuals with disabilities

• People experiencing deprivation or homelessness

• Those in settings such as prisons, schools, and social care settings

Our hope: the government commits to funding research into targeted adaptation measures that could help to improve health outcomes for each group. (Note: UK Research and Innovation – Innovate UK’s parent organisation – has already called for the establishment of a centre aimed at finding solutions to climate-related health challenges.) 

6) Alternative financing – stakeholders consulted by the report’s authors expressed concern that “the long-term approach within legislation and policy is not being married with similar long-term funding commitments or sustained resources to support effective yet efficient adaptation planning.”

Our hope: the government ensures long-term adaptation funding is available to the NHS. (Not all of it would have to come from the public purse. Look at DC Water. In 2016, the U.S. capital’s publicly owned water company, issued a $25m ‘environmental impact bond’ to fund the construction of green infrastructure, like permeable pavements.) 

We believe these six considerations are vital to building an NHS that’s fit for the future. But, there might well be more.