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PRP (37-01-04) Climate Change and health - building resilience Research Specification


Published: 19 September 2023

Version: 2.0 - October 2023

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Timetable and Budget

Deadline for Stage 1 Applications 24 October 2023, 1 PM
Notification of outcome of Stage 1 Application 09 January 2024
Deadline for Stage 2 application 20 February 2024, 1 PM
Notification of outcome of Stage 2 Application June-July 2024
Earliest Potential Project Start August 2024
Project Duration 24-36 Months
Budget £2 to £5m per project


The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for research to respond to the challenges of climate change and mitigate its impacts on health and social care systems and services, including through extreme heat and flooding.


The World is experiencing more frequent and extreme weather events thought to be being made worse by climate change. In 2022, the UK suffered extreme heat and wildfires likely made worse by climate change. Alongside flooding, overheating is one of the biggest risks the UK population faces from climate change causing significant health issues especially for vulnerable groups. For example, overheating can cause dehydration, heat stress and exasperation of existing medical conditions in both patients and the health and social care workforce, creating practical challenges and the possible need for medical interventions. In terms of extreme heat, dense urban areas like London, Manchester and Birmingham populations are particularly at risk.

As global temperatures continue to rise the risk of extreme weather events in the UK such as heat, flooding and storm surges and the challenges these pose to our heath- and social care services increase. This will include increasing demand on services, particularly for vulnerable groups, but also impacts on its infrastructure, staff and overall ability to deliver.

Due to the risks posed by climate change, the UN Climate Change Conferences (COP) have grown in importance over the last two decades. The 26th Conference (COP26) held in Glasgow in 2021 brought together world leaders to discuss measures to limit temperature rises and discuss measures to adapt to the inevitable impacts of climate change. At COP26, Professor Lucy Chappell, Chief Scientific to the DHSC and Chief Executive of the NIHR set out the need for evidence to meet the challenges of the changing climate and highlighted this as a priority for NIHR. This call has been developed to support DHSC’s and NIHR’s climate resilience work to adapt the health system to climate change in the context of extreme weather events.

In addition, under the 2008 Climate Change Act (‘the Act’), the Government is required to publish a climate risk assessment (CCRA) every five years. The Climate Change Committee (CCC) – an independent, statutory body established under the Act has a legal duty to advise Government on the CCRA. The CCRA provides the evidence base to inform Government-led national adaptation programmes (NAPs) in England, Scotland, Wales and Northern Ireland – which are a key aspect of improving climate resilience.

The third climate change risk assessment (CCRA3) was published in Jan. 2022. The CCRA3 technical report highlights the risks of climate change to health and social care delivery as an area requiring more action (risk H12), for which the Department of Health and Social Care (DHSC) is the responsible Government department. The CCRA3 briefing on health and social care summarises how this area has been assessed in the latest CCRA Technical Report and what types of action to adapt to climate change risks and opportunities would be beneficial in the next five years. Key messages include:

  • the health and social care systems across the UK are made up of people, buildings, infrastructure networks, equipment and service provision, with numerous providers. All these components are exposed to the climate hazards that will worsen as the climate changes including flooding and overheating. There could also be increasing risks from high winds or storms;
  • high temperatures lead to both increases in heat-related deaths and illnesses, and emergency service disruption from longer response times. Vulnerable people being exposed to high temperatures in hospitals, care homes and when receiving home-based care is of particular concern;
  • CCRA flood projections show that health and social care assets including hospitals, GP surgeries, care homes and emergency services stations will become increasingly exposed to flooding without additional adaptation measures;
  • health inequalities mean that the health risks from climate change are not evenly distributed (something also noted in CMO’s report on air pollution). Adaptation planning needs to consider who benefits and who is potentially disadvantaged by specific measures.

The UK Government’s third NAP (NAP3) was published on 17 July 2023, informed by the CCRA3. It sets out a strategic five-year plan (2023-2028) to boost resilience and protect people against climate change risks such as flooding, drought and heatwaves. It is a cross Government programme covering actions to address climate change across the whole country including securing food provision, a thriving natural environment and improving the planning and resilience of our infrastructure. It makes specific commitments on health and through the NIHR, DHSC wants to act further on some of the messages and risks identified above that are directly relevant for health and social care delivery.

This call forms part of wider work and initiatives from NIHR on sustainability, climate change and health, and complements a Research and Innovation for Global Health Transformation (RIGHT) call, Strengthening health service delivery and resilience in LMICs in the context of extreme weather events.

Research priorities

The focus of the call is to respond to risks posed by climate change to health and social care delivery in the UK and help build resilience into the system through adaptation.

Priority will be given to applications focusing on clear evidence gaps, and interventions and solutions that mitigate risks from extreme weather events – with heat and flooding a priority.

We are keen to cover all aspects of health and care delivery in terms of research funded – including social care.

Generic issues applications must consider:

  • Vulnerable groups and health disparities - climate change and extreme weather doesn’t affect people equally. There are specific vulnerable groups and it’s important that health disparities are factored into any research proposal;
  • Areas that experience the most negative impacts of climate change e.g. dense urban areas and areas prone to flooding;
  • Impact - researchers are asked to work with those who use, work in and manage services to focus the research where there will be most benefit;
  • Translatability - it will be beneficial if emphasis is placed on applications for real-life scenarios, and researchers are encouraged to work closely with stakeholders to help ensure work focuses on solutions and is translatable;
  • Economic costs - to support translation and implementation cost effectiveness of any interventions is an important aspect. Understanding the financial implications and benefits associated with various climate change adaptations can help inform local decision-making and will help ensure the outcomes of the research are economically viable;
  • Adding value. Research proposals will be expected to be clear about how they will complement, and develop, existing work and how it will help deliver solutions.

Research priority areas:

Key questions where we feel there are key evidence gaps include:

  • How vulnerable and resilient are different aspects of our health and social care services in the UK?. What aspects of services are most vulnerable and which are most resilient?
  • What is the capacity and preparedness of health and social care systems to respond effectively to heat and other extreme weather – specifically including advanced preparations and adaptations, and what more services and systems can do to be prepared?
  • What effective and equitable response measures to the health risks associated with heat and extreme weather can be taken that can be applied to health and social care to minimise the heat-health disparities and inequality? Intervention options could be funded and evaluated (including cost-effectiveness) as part of a successful application but must be focused on health and social care;
  • What are the projections of heat and health impact with and without adaptation interventions to provide a business case for these interventions and solutions?
  • What are the most effective strategies for targeting and adapting most vulnerable building types – what are the most suitable measures for different designs/ models e.g. window opening and shading may not be suitable or provide sufficient resilience against extreme heat events.
  • What are the costs to the health and care system of extreme weather events and practical, affordable /cost-effective adaptations to mitigate these types of events to support more stringent adaptation measures?
  • What measures can be put in place to support the health and care workforce through extreme events, e.g. maintaining safe working conditions and buildings, managing heat-stress and protecting the mental health of the workforce? Are there areas that are more vulnerable or better prepared, and what are the areas of most concern to the workforce?
  • What interventions could be put in place to protect key systems and functions e.g. IT, communications, medical devices, medicines, power, clean water, sanitation?

Areas for consideration may include any aspect of health and care services being able to operate including:

  • cancelled/ missed appointments e.g. due to travel disruption for patients and healthcare workers;
  • ways to mitigate disruption from extreme and/or extended events, particularly for vulnerable groups and in ways that do not wider health disparities;
  • impact on staff working conditions, patients and residents, including on mental health, and practical measures to protect individuals;
  • loss/damage of equipment, facilities and healthcare spaces /measures - adaptations, processes and systems to protect infrastructure and building (including the most critical areas)
  • ability to delivery services safely and across vulnerable geographical areas;
  • lost productivity and/ or risks to health (e.g. limiting time use of PPE) due to heat and ability to provide services.

Areas out of scope for this programme of work

Although related, air pollution is out of scope as are other areas of climate change and health e.g. tick borne diseases, disease transmission.

Building resilience in a wider societal context which is not focused on health and social care services.

Supporting the NHS and social care to get to net zero is out of scope.

Epidemiological and other studies demonstrating the impact of climate change on human health. These are well established and researchers are encouraged to look at solutions to make services more resilience to extreme weather.

We would like researchers to be cognisant of the Government’s net zero target when considering adaptations and interventions, and ideally for these to be low carbon.


Eligibility for the NIHR PRP is laid out in our Standard Information for Applicants and applies to all calls unless otherwise stated in the individual research specification.


Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers will need research evidence to meet key policy decisions and timescales, so resource needs to be flexible to meet these needs. A meeting to discuss policy needs with DHSC officials will be convened as a matter of priority following contracting.

Researchers will be expected to work closely with DHSC from the outset, and during the course, of the research to ensure research remains impact focus, practical, translatable and solution driven.

Budget and duration

Maximum budget will be £3-5 m depending on the proposal, expected output and impact on policy, decision making and translatability. Smaller allocations may be deemed suitable for projects in innovative areas to encourage different approaches and develop expertise, and interdisciplinary working in this area.

Projects are expected to be completed within 3 years.

Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning committee members will assess applications against.

Management arrangements

A research advisory group including, but not limited to, representatives of DHSC, other stakeholders and the successful applicants for the research should be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:

Provide regular feedback on progress

Produce timely reports to the advisory group

Produce a final report for sign off

Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR. Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review.

Guidance on Health and Care Inequalities and associate data collection within NIHR PRP Research:

Health and care Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects.We are now assessing all NIHR research proposals in relation to health inequalities. We ask that you please clearly identify in the research plan section of the application whether your application has an inequalities component or theme as well as how this research hopes to impact inequalities or not. Please also detail the core set of inequality breakdown data that will be collected, if applicable. More information on this request can be found in the Standard information for applicants.

References and key documents