You report on hospitals declaring critical incidents as their systems fail in the heat (Hospitals in England declare critical incidents as machines and IT fail in heat, 25 June). This is a crisis that health professionals saw coming.

It is not England’s alone. During June’s record-breaking European heatwave, France raised its health system to the highest level of emergency mobilisation, while hospitals across Italy, Spain and Germany reported surging admissions and cooling systems that could not cope. Everywhere, the people caring for patients are working sleep-deprived in sweltering, un-air-conditioned wards, with consequences for both staff wellbeing and the safety of care. Across Europe, we are hearing from health professionals that conditions are becoming dangerous and systems remain unprepared.

The European Federation of Nurses Associations (EFN) has endorsed Health Care Without Harm Europe’s #HandleTheHeat campaign because nurses across the continent recognise that responding to extreme heat requires more than emergency measures once temperatures soar.

The warning signs have been there for years. Nearly half of hospitals in European cities sit in urban heat island hotspots. In a 2024 survey of more than 1,000 UK healthcare professionals, over 90% said heat stress impaired their performance and nearly three‑quarters called existing protections inadequate.

Europe cannot keep reacting to extreme heat after the fact. As the World Health Organization launches the new heat-health action plans guidance and the European Environmental Agency steps up efforts to strengthen climate resilience, the direction is clear: move beyond risk communication to implementation.

Health professionals across the continent are signing an open letter to the European Commission calling for an EU climate and health strategy, stronger workforce protections, support for low‑carbon, climate-resilient healthcare facilities, and more.

Extreme heat is not an exceptional event and Europe’s response to it should stop being exceptional too. Protecting patients and those who care for them must become a core part of climate adaptation policy, not an afterthought.
Mark Wilson Executive director, Health Care Without Harm Europe, and Dr Paul De Raeve Secretary general, EFN

As we’ve seen from the impacts of the heatwave on the NHS, the climate crisis is unquestionably a health crisis. As the UK’s largest public service, the NHS is also the country’s largest public-sector source of carbon emissions, contributing to climate change and, in turn, affecting human health. This creates a vicious loop: worsening health drives greater demand for care, further increasing emissions.

The news of hospitals declaring critical incidents during last week’s heatwave is sadly unsurprising. Extreme weather events like heatwaves, flooding and storms are likely to become more frequent. And yet, the NHS 10-year plan – which sets out a vision for transforming healthcare delivery in England – has no specific proposals that explicitly address how to decrease NHS carbon emissions or how it interacts with the NHS 4th Health and climate adaptation report.

There is an overwhelming risk that much-needed decarbonisation and adaptation activities are deprioritised amid the competing reforms and scant resources faced by the NHS. To avoid this, the intersection of climate resilience and health has to be a core component of public health strategy. It can’t be a peripheral concern.
Nadine Henderson
Principal economist, Office of Health Economics