NHS may need ‘winter-style’ planning to cope with increasingly hot summers

The NHS may need to prepare for increasingly hot summers in much the same way it plans for winter, England’s chief nursing officer has suggested, after high temperatures placed additional pressure on health services and created difficult conditions for staff and patients.

Duncan Burton said the health service would need to increase its planning for hotter summers in future, acknowledging that high temperatures had contributed to increased pressures across the NHS this year. His comments raise a wider question about whether extreme heat is becoming a predictable seasonal challenge that health services must routinely prepare for rather than an occasional weather emergency.

Writing in his latest Chief Nursing Officer bulletin, Burton thanked nurses and other NHS staff for continuing to deliver care in challenging working conditions. Despite the pressures, he said NHS teams had treated and discharged more patients within four hours than in June and delivered the best performance against the 18-week planned care target for almost five years.

However, he warned that preparations may have to change as hotter summers become more common, saying the NHS would need to increase its planning for summer heat in the same way it prepares each year for winter.

Winter planning is already a major annual operation for the NHS. Integrated care boards and providers are required to assess expected demand and capacity, prepare for surges in illness, organise vaccination programmes, consider staffing and hospital occupancy and make arrangements with primary care, community services, mental health providers, local authorities and social care. For winter 2026/27, local systems were required to have draft plans completed by the end of August before undergoing regional stress-testing exercises in September.

Applying a similar approach to summer would represent a significant change in how the NHS thinks about seasonal pressure. Traditionally, winter has brought the greatest concern because of flu, Covid-19, norovirus and other respiratory illnesses, alongside cold weather and increased demand from older and vulnerable patients. Extreme heat, however, creates a different set of pressures for both the population and the health service caring for them.

Hot weather can be particularly dangerous for older people, babies, people with cardiovascular or respiratory conditions and those taking certain medications. Heat can contribute to dehydration, heat exhaustion and heatstroke, while also worsening existing health problems and increasing demand for urgent and emergency care.

The challenge does not stop with patients. This summer has also renewed concerns about conditions inside NHS buildings, many of which were designed long before the temperatures now being experienced in England were anticipated.

The Royal College of Nursing has reported cases of nursing staff collapsing at work during periods of extreme heat and warned that some staff were dreading shifts because of temperatures inside healthcare settings. General secretary and chief executive Professor Nicola Ranger has called extreme heat caused by climate change a public health emergency and urged greater investment in adapting health and care facilities.

The government has acknowledged that extreme heat can pose serious risks to hospitals, GP surgeries and other healthcare buildings. NHS organisations are required to have adverse-weather arrangements and monitor temperatures locally, while national technical standards include requirements covering ventilation, cooling and climate resilience.

But adapting an enormous NHS estate is considerably more complicated than installing air conditioning. Hospitals contain wards, operating theatres, laboratories, pharmacies, kitchens, diagnostic equipment and specialist clinical areas, all of which can have different ventilation and temperature requirements. Older buildings can be particularly difficult and expensive to modify.

The government’s 10 Year Capital Plan for Health and Social Care includes a renewed focus on climate resilience, with plans for every NHS region to conduct an adverse-weather emergency response exercise by 2030. Officials also intend to model the future impact of heat on population health and hospital admissions and explore structural adaptations to NHS buildings, including passive cooling measures.

Around £6.75 billion is due to be invested over nine years to address some of the most critical infrastructure risks across the NHS estate, including ventilation and cooling systems. New Hospital Programme projects and new neighbourhood health centres are also expected to incorporate climate resilience into their designs.

Burton’s suggestion raises the possibility that summer preparedness could eventually become much more systematic. That could mean services modelling the likely increase in emergency demand during heatwaves, identifying vulnerable patients before temperatures rise, reviewing staffing arrangements, ensuring adequate supplies and hydration, checking cooling and ventilation systems and developing escalation plans for prolonged periods of extreme heat.

It could also require greater coordination with social care. Care homes and home-care services support many of the people most vulnerable to high temperatures, while local authorities are responsible for ensuring continuity within their local care markets. Current UK Health Security Agency guidance advises care homes to prepare in advance, respond early to Heat-Health Alerts and prioritise residents at greatest risk through increased monitoring, hydration and measures to control indoor temperatures.

The NHS is simultaneously preparing for the more familiar challenge of winter. Burton said his team was already looking ahead to the coming months, with flu vaccinations beginning for pregnant women and children from 1 September. NHS England’s winter plan also requires health systems to maximise vaccination uptake, maintain urgent primary care capacity, strengthen community services and prepare for surges in demand.

The prospect of having to prepare extensively for both seasons illustrates how the NHS’s operational challenges are changing. Winter pressures have been part of health-service planning for decades, but increasingly frequent periods of extreme heat mean summer can no longer necessarily be regarded as the quieter part of the year.

Burton has not announced a formal national summer planning programme equivalent to the NHS winter plan. His comments do, however, indicate that senior NHS leaders are considering whether more structured preparation will be necessary as temperatures rise.

If hotter summers become a regular feature of life in England, the question facing the NHS may no longer be how it responds when a heatwave arrives. Increasingly, it will be how hospitals, community services, social care and the NHS estate prepare for extreme heat before summer begins.

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