Governing the Climate Adaptation of Care Settings

As a result of global climate change, the UK is expected to experience hotter and drier summers, and heatwaves are expected to occur with greater frequency, intensity and duration. In 2003 and 2018, 2,091 and 863 heat-related deaths, respectively, were reported in England alone as a result of heatwaves, meaning future temperature increases could lead to a parallel rise in heat-related mortality. The UK also currently has a rapidly ageing population, with people aged 75 or over expected to account for 13% of the total population by 2035. Older populations are more vulnerable to climate-induced effects as they are more likely to have underlying, chronic health complications, making them more vulnerable to heat stress. The indoor environment is a principle moderator of heat exposure in older populations, who tend to spend the majority of their time indoors. Poor building design, the lack of effective heat management and diverging needs and preferences between staff and residents in care settings may contribute to increased indoor heat exposure with detrimental health impacts falling on the most vulnerable residents. Maladaptation to a warming climate, such as the uptake of air conditioning, could increase fuel bills in care homes, increase operational costs for businesses in the already financially stretched care sector, and increase building carbon emissions, thus undermining government efforts to reduce greenhouse gas emissions.

The one-year pilot project 'Climate Resilience of Care Settings' and previous small-scale studies led by our research team have shown that UK care homes are already overheating even under non-extreme summers. A key target for climate adaptation in care settings is to limit such risks by introducing passive cooling strategies via building design. However, preliminary modelling as part of the pilot project also demonstrated that common passive cooling strategies may not adequately mitigate overheating risk in the 2050s and 2080s. Further research into advanced passive cooling strategies, combined with human behaviour and organisational change is required to identify optimum climate adaptation pathways for UK's care provision.

The main aim of the project is to quantify climate related heat risks in care settings nationwide and enhance understanding of human behaviour, organisational capacity and governance to enable the UK's care provision to develop equitable adaptation pathways to rising heat stress under climate change. Building on the foundations of the pilot project, this novel, interdisciplinary project will collect, for the first time in the UK, longitudinal temperature and humidity data in a panel of 50 care settings in order to quantify the recurring risk of summertime overheating. We will also identify and assess social, institutional and cultural barriers and opportunities underpinning the governance of adaptation to a warmer climate in care and extra-care homes through surveys with residents, frontline care staff, managers and policy stakeholders. Within sub-samples of this panel, we will use innovative measurement techniques to collect residents' physiological data and study their relation with heat exposure and health impacts. Also for the first time in the UK, we will create a building stock model of the UK's care provision able to predict future overheating risks in care settings under a range of future climate change scenarios. This will help evaluate the effectiveness of near, medium and long term future overheating mitigation strategies and policies on thermal comfort and health outcomes. Throughout the project, we will continue to develop and expand the stakeholder community that was created during the pilot project. Through ongoing dialogue with our diverse network of stakeholders, we will explore organisational capacity and structures, and how these influence action and policy, in order to generate best practice guidance for practitioners, businesses and policymakers.

Direct beneficiaries of the research project are UK policymakers, such as Government departments and other regulatory agencies, who are responsible for developing and introducing climate mitigation and adaptation policies, and policies for the improvement of the social care sector in the UK. Developing a number of effective policy interventions aims to protect the UK from the challenging effects rising temperatures will impose on UK infrastructure and the health and social care system. Further policymakers, such as Local Governments, will also benefit from the work as responsibility for local care settings falls under their remit and, therefore, protecting the health of the vulnerable individuals in such settings is of utmost priority.

There is currently wide recognition of the negative health effects associated with exposure to cold weather in older populations, meaning overheating risks can be overlooked. Given the way external temperatures within the UK are expected to rise due to climate change, it is likely that there will be large impending health effects if the research area remains neglected, causing a future strain on the health system. Thus, public health professionals will also benefit indirectly from the work as they aim to protect population health, particularly that of vulnerable communities within society, such as the target population of care home residents. Understanding factors which contribute to overheating in care settings using a holistic approach (e.g. considering building characteristics, occupant behaviour and interactions between staff and residents) allows for the development of effective mitigation strategies which can be implemented into care settings in a timely manner. Targeted interventions are more cost-effective, reducing the financial costs needed to implement policies and the subsequent burden on the health system. The built environment research sector also stands to benefit from the work as it will contribute to the understanding of measures which reduce overheating risk, specifically in the care sector but also applicable more generally to other domestic buildings.

The ultimate beneficiaries of the project, supported by the introduction of appropriate policies, will be the target population who live in care settings and are currently at risk of being exposed to high indoor temperatures leading to detrimental effects on health. Further details of the project beneficiaries and associated pathways to impact are provided in our Pathways to Impact section.

Multiple routes will be pursued to maximise stakeholder benefit and allow for effective sharing of expertise as part of our Pathways to Impact Plan. Specific Investigator and PDRA resources, and a whole Work Package are dedicated to our research impact activities that will help translate our research findings into meaningful outputs for policymakers, co-create knowledge and identify optimum pathways for dissemination amongst other relevant stakeholders. We will also assemble a Project Advisory Board (PAB) including representatives of each stakeholder group and organise six PAB meetings combined with stakeholder workshops throughout the duration of the project. This will create an interdisciplinary, collaborative environment between our research team, policymakers and practitioners that will encourage two-way conversations. It is expected that the project outputs will be used to inform and update current industry standards, such as CIBSE guidance, and public health risk assessment approaches, such as the CQC inspection processes. Other platforms of dissemination include our planned closed collaboration with the UKRI UK Climate Resilience Champion, the Met Office, the CQC, MHCLG, PHE, CIBSE, the UCL Public Engagement Unit, the UCL Media Relations team and the Bartlett Strategic Communications team, who will support engagement activities between our research group, interest groups outside academia and the wider public.