Heatwaves, hospitals and health system resilience in England: a qualitative assessment of frontline perspectives from the hot summer of 2019

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Introduction

This study explores how increasingly frequent and severe heatwaves in the UK—driven by climate change—expose vulnerabilities in healthcare infrastructure and hospital environments, where up to 90% of buildings are prone to overheating and may exceed recommended temperature ranges, thereby compromising patient safety and staff well-being

Methodology

Researchers conducted a qualitative study during the summer 2019 heatwave, employing pre-interview surveys and semi-structured interviews with 14 NHS staff across England—including clinicians, facilities managers, and emergency preparedness professionals—selected via purposive and snowball sampling until thematic saturation was reached. Data were analyzed using thematic analysis to capture experiences and challenges related to heat exposure in healthcare settings

Results

Disruption and discomfort: Hot weather markedly disrupted healthcare delivery, including patient admissions, staff comfort, and functioning of facilities and equipment.

Awareness gaps: Staff exhibited varying levels of knowledge about the Heatwave Plan for England, Heat-Health Alerts, and associated guidance—clinicians and non-clinical staff differed in their familiarity with preparedness protocols.

Conflicting priorities: Heatwave responses were complicated by competing demands such as infection control, concerns over electric fan use, and maintaining patient safety under unusual conditions.

Conclusions

Healthcare delivery staff experience difficulty in managing heat risks in hospitals. Priority should be given to workforce development and strategic, long-term planning, prevention and investment to enable staff to prepare and respond, as well as to improve health system resilience to current and future heat-health risks. Further research with a wider, larger cohort is required to develop the evidence base on the impacts, including the costs of those impacts, and to assess the effectiveness and feasibility of interventions. Forming a national picture of health system resilience to heatwaves will support national adaptation planning for health, in addition to informing strategic prevention and effective emergency response.

Citation

Ward, K., Stowell, A., Hajat, S., & Kovats, S. (2023). Heatwaves, hospitals and health system resilience in England: A qualitative assessment of frontline perspectives from the hot summer of 2019. BMJ Open, 13(3), e068298.