Objective: Whilst the implications of climate change for public health continue to be elucidated, we still require much work to guide the development of a comprehensive strategy to underpin the adaptation of the health system. Our aim is to focus on the health system responses to health risks from climate change, and in particular how best to prepare Australian health services for health risks from; heatwaves, bushfires, infectious diseases, diminished air quality and the mental health impacts of climate change. Approach: We present some guiding principles for preparing health systems, and also overview some specific preparatory activities in relation to personnel, infrastructure and coordination. Conclusion: Increases in extreme weather related events superimposed upon health effects arising from a gradually changing climate will place additional burdens upon the health system and challenge existing capacity. Preparing the health system for climate change requires investment in personnel, infrastructure and service coordination. Key characteristics of a climate change prepared health system are that it should be flexible, strategically allocated and robust. Long term planning will also require close collaboration with the non-health sectors as part of a nationwide adaptive response.