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How will the heatwave impact the NHS?

As temperatures climb beyond 40ºC, the health service has to deliver despite staff shortages and crumbling infrastructure.

By Zoë Grünewald

In case you haven’t noticed, it’s getting pretty hot. In fact, the UK had its hottest day on record yesterday, and is expected to break that record again today, with temperatures forecast to reach up to 42ºC. This is the first time that the Met Office has ever issued a red extreme heat warning, and experts predict this might not be such an uncommon occurrence as the years go on.

As we all cower inside with the curtains drawn, the National Health Service has to deal with the fallout of the weather and provide essential services in infrastructure made for other climes.

How bad will it get?

During heatwaves, there is a higher incidence of death, especially in vulnerable groups, such as the elderly and those with underlying health conditions. Specifically, there tends to be higher deaths in those with cardiovascular and respiratory diseases. The current heatwave is only predicted to last two days, but experts warn that is enough time to cause significant excess deaths, travel disruption and damage to infrastructure.

Local authorities have also warned of pressure on emergency services and hospitals as a result of people trying to use rivers, lakes and the ocean to cool down. Last year, 255 people died as a result of accidental drowning. Four people are reported to have drowned yesterday, trying to escape the heat.

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Former government chief scientist David King told LBC on Saturday that we could potentially see up to 10,000 excess deaths during Monday and Tuesday alone. During the 2003 heatwave, there were 2,139 excess deaths in this country.

[See also: Climate change: Welcome to the inferno]

How does this affect the National Health Service?

On Friday, the British Medical Journal (BMJ) set out the extent of the issue for the NHS, saying that “NHS trusts across England reported 4,131 incidents between April 2020 and March 2021 when ward or other clinical area temperatures rose above 26°C – the point at which, according to NHS England’s heatwave plan, a risk assessment needs to be conducted and vulnerable patients protected… and as temperatures are soon expected to hit record highs across the country, incidents of dangerous temperatures could get worse.”

A number of significant and potentially avoidable factors mean that a heat-related health service crisis could be exacerbated. These include shortages of beds, staff and ambulances. Unfortunately, these shortages are also coupled with the fallout from the Covid-19 pandemic, as well as rising infection rates. It is being reported that there are significant workforce absences as a result of staff themselves testing positive. Earlier this week, the East Anglian Daily Times reported that 271 out of 11,600 staff were off work due to Covid in Colchester and Ipswich hospitals and community services in north-east Essex and east Suffolk.

As pressures on staff increase with a likely influx of patients needing urgent care in the heat, the BMJ also warned that NHS staff may get dehydrated in the heat: “Because the summer has been busier, staff are less inclined to take their breaks – and to grab a drink.”

The health service has structural issues that may also cause problems. Matthew Taylor, chief executive of the NHS Confederation, the membership organisation that represents the healthcare system in England, Wales and Northern Ireland, told Sky News yesterday morning that there was a problem of resilience in the NHS. “The NHS has 2,000 vacancies,” he said. “It’s [also] got an estate that is crumbling, so many are not the kind of buildings that have got the adaptability [for] these kinds of challenges.”

The BMJ, too, highlighted crumbling infrastructure as a key issue: “Hospitals’ heat problems stem in part from the age of the infrastructure. A third of the NHS estate was built before 1965 and 14 per cent before the foundation of the NHS in 1948, according to a 2020 National Audit Office report. With age comes problems. ‘High-risk backlog maintenance’ – issues that require urgent fixes to prevent catastrophic failure and disruption to clinical services – rose 139 per cent between 2014-15 and 2018-19.”

Is there no plan in place?

Public Health England drew up a heatwave plan following the deadly heatwave in 2003, which killed 20,000 across Europe. The plan outlines four levels that hospitals and other health and social care services should follow, which increase with severity according to the temperature. Level 4, the highest, was announced for the first time on 15 July in preparation for this week’s heatwave. This means hospitals will be implementing special measures for patients, and the government will orchestrate issuing official advice to the population.

However, there are still considerable structural challenges in place. “Our buildings and estate are ill-equipped to deal with these kinds of temperatures, and a lack of capital investment in the NHS over the last ten years means we have very little resilience left to deal with crisis situations like this,” Taylor warned.

So, how can I keep myself safe in the heat?

An excellent question: stay indoors, drink plenty of fluids, and look out for those who may be vulnerable in these temperatures, such as the elderly, those with chronic conditions or those who live alone.

Read and follow this government advice, and hang on in there – it’ll feel cooler tomorrow.

[See also: Does the UK need new heatwave working laws?]

[See also: The NHS is still a long way from net zero]

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