Climate change adaptation can be defined as a form of risk management (i.e. assessing climate change-related risks and responding appropriately so that the risks can be pre-emptively minimised and managed as they arise). Adapting to climate change by hospital and community health services will entail responding to changing health needs of the local population, and to the likely effects of climate change on health service resources, workforce and infrastructure. In this paper we apply a model that health services can use to predict and respond to climate change risks and illustrate this with reference to Sydney's Local Health Districts (LHDs). We outline the climate change predictions for the Sydney metropolitan area, discuss the resulting vulnerabilities for LHDs and consider the potential of LHDs to respond. Three 'core business' categories are examined: (1) ambulance, emergency and acute health care; (2) routine health care; and (3) population and preventative health services. We consider the key climate change risks and vulnerabilities of the LHDs' workforce, facilities and finances, and some important transboundary issues. Many Australian health services have existing robust disaster plans and management networks. These could be expanded to incorporate local climate and health adaptation plans.What is known about the topic? There is an inextricable relationship between climate change and human health, with important implications for the delivery of health services. Climate change will affect health service demand, and the resources, workforce and infrastructure of health services.What does this paper add? This paper outlines how local health services can use existing data sources and models for assessing their climate change-related risks and vulnerabilities to predict, prepare for and respond to those risks. This is illustrated with reference to Sydney's LHDs.What are the implications for practitioners? Adaptation to climate change by health services is an important component of risk management. Local health services need to prepare for the effects of climate change by assessing the risks and developing and implementing climate and health adaptation plans.