Reframing climate change as core NHS leadership responsibility on boards

Climate change is an escalating public health emergency, yet within the National Health Service (NHS) it remains marginal to board-level leadership and governance. Despite its direct implications for population health, service resilience and health inequalities, responsibility for climate action is often delegated away from strategic decision-making forums.

This article draws on the author's experience as the NeXt Director (Non-Executive Director in Training) with a remit for future generations, including climate change and sustainability, on a newly established Integrated Care Board in England.

Using a reflective leadership lens, the article examines how climate change was reframed from a peripheral sustainability issue into a core governance and risk concern. Practical strategies included embedding climate-related threats into formal risk registers, aligning climate action with population health and inequality priorities and integrating climate considerations into existing strategic and operational levers.

Positioning climate risk within established governance structures shifted board-level engagement, normalised climate-informed questioning in strategic discussions and enabled early integration of climate considerations into population health, commissioning and resilience planning. These changes established climate change as a shared leadership responsibility rather than a siloed agenda.

The article argues that NHS leadership models must evolve to address long-term, systemic risks such as climate change. Boards should treat climate change as a determinant of quality, safety and equity, embedding it within risk management, strategy and accountability frameworks to ensure system preparedness in an increasingly unstable climate.