WIREDGOV

Extreme weather, supply‑chain shocks and rising inequalities are affecting public services. Chris Naylor explores five implications of climate change for health care and other public services. 

Climate change is not an ‘environmental’ problem – it is the backdrop for everything governments do. It now shapes our lives in countless ways, seen and unseen. In doing so it creates new pressures for public services and makes existing social challenges more pernicious. As part of our work on reimagining the welfare state, I outline five broad implications for health care and other public services.  

1. Climate change is creating operational risks for public services and re-shaping demand 

Public services are feeling the impact of climate change already. Extreme weather events in the UK have caused significant service disruption, for example in the form of serious IT failures following the heatwaves of summer 2022. Dependency on complex global supply chains means services are also vulnerable to the effects of extreme weather elsewhere – as seen with concerns about supplies of intravenous fluids following damage caused by Hurricane Helene in 2024. Incidents such as these are expected to become more common and more severe as ‘extreme’ weather becomes increasingly routine. 

Climate change is also re-shaping demand for services and exacerbating inequalities. For example, estimates suggest around a third of the inflation in food prices seen in the UK in 2023 was attributable to extreme weather in food-growing countries. There has been a disproportionate impact on the price of healthier foods which have become increasingly unaffordable for people on lower incomes. This reinforces inequalities and adds to pressure on public services. 

The government’s climate change risk assessment highlights other ways in which the health and wellbeing of the population is changing as a result of climate change, including the growth of eco-anxiety, heat-related mortality and the increasing prevalence of vector-borne infections such as Lyme’s disease. It also details broader risks such as insecurity in food, water and energy supplies, and economic instability – all of which have knock-on effects on people and on public services. 

2. Decarbonisation means changing how services are delivered  

Public services are themselves significant contributors to climate change – the NHS alone is responsible for around 5% of UK carbon emissions. A key challenge for public sector leaders is therefore to design services that are high quality and low carbon. Carbon footprint analysis shows this needs to involve more than having energy-efficient buildings. Broader changes to services are also needed to ensure environmental costs are minimised while maximising the outcomes achieved for the population. 

Sustainability principles indicate the sorts of changes that need to be made, including reducing the need for more resource-intensive services through prevention, empowerment and community-led change, and ensuring that wasteful processes and low-value interventions are removed. Changes of this kind cannot be left to sustainability experts – they need to be led by the people who deliver services in partnership with the people who use them. 

3. Success depends on grappling with the underlying drivers of activity growth 

Climate change casts a new light on concerns about the growing cost of public services. There is a limit to which public services can respond to complex social challenges by simply ‘doing more’. This point is illustrated by analysis of NHS carbon emissions over the last five years, which shows that despite the NHS becoming more carbon efficient (in terms of emissions per patient treated or per pound spent), total emissions remain stubbornly high1 because the NHS is providing ever more care. 

As part of the transition to a low carbon economy, government therefore needs to tackle the underlying drivers of activity growth in public services. These drivers are many and varied – and often complex to address – so it makes sense to focus on policy areas that offer the prospect of simultaneous health, social, economic and environmental benefits.  

One example is food policy, which the EAT-Lancet Commission argues is the ‘single strongest lever to optimise human health and environmental sustainability on earth’. Changing the way food is produced, processed, regulated and consumed could take pressure off public services by reversing falls in healthy life expectancy, improving employment rates and restoring the planetary systems on which life and economies depend.  

4. Short-term thinking lies at the heart of the problem 

Our recent research highlights that one of the key barriers to delivering low carbon public services is short-term decision-making and budgeting. Pressure to balance the books in the current financial year means that services avoid making changes that would save money in subsequent years, while also improving service quality and reducing environmental damage. Examples include investing in renewable energy generation and switching to reusable products. As with many sustainability interventions, these typically generate savings greater than the upfront costs – for example, the anticipated £325 million lifetime savings from recent NHS investment in solar power. 

Recent moves in the Medium-Term Planning Framework to introduce multi-year capital budgets in the NHS take a step in the right direction, but without a more fundamental shift – including changes to Treasury rules to make invest-to-save propositions more viable – public services will continue to make wasteful and environmentally destructive decisions in the name of short-term cost control. 

5. Redefining what we mean by ‘value’ 

A final barrier is cognitive overload. Working in public services is hard enough already without the added burden of climate change to shoulder. For that reason, sustainability needs to be an automatic part of existing processes rather than an additional problem for individuals to solve. One way to do that is to expand the definition of value used in public policy and management. Value is about the outcomes delivered relative to the inputs invested and is typically understood in terms of value for money. To embed sustainability in public service delivery, environmental and social costs need to be considered alongside financial costs, as part of the same processes. UK governments have already taken steps in this direction by introducing requirements to consider social value as part of procurement processes. Going further on this, for example by including environmental costs in NICE assessments, would make it easier for staff to make sustainable choices without this adding to their workload. 

A central theme in our work on the future of public services, which aims to re-examine the ideas first set out in Beveridge’s 1942 report, is the relationship between individuals, communities and the state. The challenges I’ve raised above are, first and foremost, the responsibility of government and public sector leaders to solve. But there will also need to be sufficient support and action from the wider public. Getting this relationship right – in a context where trust is often low and misinformation abounds – will be key. 

The latest climate science shows how high the stakes are: if governments fail to take sufficient action on climate change, the economic and social fabric that the welfare state depends on could unravel entirely. All of us who care about the future of public services need to engage with the sorts of issues outlined here. Otherwise we may be guilty of an epic act of deckchair shuffling as the good ship Beveridge, and much else besides, sink without trace.