The onset of cold weather and the start of winter is a busy time for the UK health and social care agencies and services. Cold weather can have a serious impact on the health and lives of many people, particularly the old or the vulnerable, and is responsible for many deaths and illnesses each year. This year the Government has published the Cold Weather Plan for England to try and help people and services cope through the winter months. Martin Hodgson looks at what the plan says and what domiciliary care managers can do to ensure the welfare of their service users in the cold weather.

Problems with the cold

Every year, winter weather and cold are associated with an increase in illnesses, injuries and mortality. Cold weather increases the risk of heart attacks, strokes, lung illnesses, flu and other diseases, and accident rates also increase. People slip and fall in the snow or ice, suffering serious injuries, and other accidents such as road traffic accidents increase. Some groups, such as older people and people with pre-existing medical conditions, are particularly susceptible to the effects of very cold weather.

And for some, cold weather can even be fatal.

Approximately 27,000 more people die each year in England over the winter months compared with other times of the year. This is often referred to as “excess winter deaths” or “excess winter mortality”. Very severe weather can substantially add to this death toll.

Winter conditions not only create health risks for individuals, but also place a huge burden on adult social care, health and emergency services as they struggle to cope with the additional numbers of people who require help. Hospital wards fill up and infectious diseases such as Norovirus put health and social care organisations under great strain.

Some warn that this year could be worse than usual, whatever the severity of the weather. They fear that the financial problems of the recession have squeezed the finances of families and households and that, as a result, many people will not be able to afford to keep their homes as warm as they struggle to cut household costs.

Cold homes

Things are made worse if vulnerable people are living in poor housing conditions.

People living in unmodernised homes or in poor housing conditions are more at risk of ill health during cold weather, and a recent report by Age UK suggests that illnesses related to living in a cold home could cost the NHS £1.36 billion every year.

Cold housing increases the level of minor illnesses such as colds and flu and exacerbates existing conditions such as respiratory illness, arthritis and rheumatism. The stress of living in cold conditions contributes to a higher rate of mental health problems, including depression. Most importantly, there are more deaths, especially in the winter, many attributable to cardiovascular disease and respiratory disease.

The charity says thousands of older people are dying prematurely due to the health effects of living in the cold and it is urging the Government and local authorities to help improve energy-saving measures in homes in a bid to reduce winter deaths.

The Age UK report, The Cost of Cold: Why We Need to Protect the Health of Older People in Winter, states that the root of the problem is poorly insulated homes and the increases in energy bills in recent years that have made older people cut back on heating to save money.

Every death or serious illness is a personal tragedy for the individual and family involved, the report points out, and these deaths are largely preventable. Other colder countries such as Finland have significantly lower death rates due to better insulated homes and greater awareness of the need to keep warm.

Poor housing and cold homes are often linked to the problem of fuel poverty, a condition which is said to occur when the members of a family cannot afford to keep their home adequately warm at reasonable cost given their income.

In early 2008 it was estimated by Energywatch that there were around 4.4 million households in fuel poverty in the UK, with just over 3 million in England alone.

The Cold Weather Plan for England

Cold Weather Plan for England 2012: Protecting Health and Reducing Harm from Severe Cold provides advice for individuals, communities and agencies on how to prepare for and respond to severe cold weather and is supported by a Met Office cold weather alert service that started in November and runs until the end of March 2013.

The plan has been written for health and social care services and other public agencies and professionals who interact with those most at risk from cold weather in winter. It is designed to help reduce the significant increase in winter deaths and illness that is observed each year. This, in turn, could help to reduce pressures on the health and social care system in the busiest months of the year.

It is also intended to mobilise individuals and communities to help them protect their neighbours, friends, relatives and themselves against avoidable winter health problems.

The plan recommends a series of steps to reduce the risks to health from prolonged exposure to severe cold weather for:

  • the NHS, local authorities, social care, and other public agencies

  • professionals working with people at risk

  • individuals and local communities.

The plan is supported by a companion volume, Cold Weather Plan 2012: Supporting the Case, which gives further information about cold weather planning as well as a series of handy “action cards” taken from the plan as a guide for easy reference for organisations and staff.

Met Office alerts

The Cold Weather Plan is underpinned by a system of Cold Weather Alerts, developed with the Met Office. Improvements have been made to this system following feedback from previous years. The Cold Weather Alert service operates in England from November 2012 to 31 March 2013. During this period, the Met Office may forecast periods of severe cold weather on the basis of either low temperatures or widespread ice and/or heavy snow.

The Cold Weather Alert service has been updated and now comprises five main levels.

  • Level 0: Winter preparedness — long-term planning. This emphasises that to build resilience for the coming winter requires long lead-in planning times.

  • Level 1: Winter preparedness. This is in force throughout the winter from November to March and indicates that preparations should be in place to protect health and ensure service continuity in the event of severe cold and winter weather.

  • Level 2: Severe winter weather — Alert and readiness. This is declared when the Met Office forecasts a 60% risk of severe winter weather in one or more defined geographical areas in the days that follow. This usually occurs two to three days ahead of the event.

  • Level 3: Severe weather action. This is issued when the weather described in Level 2 actually happens. It indicates that severe winter weather is now occurring, and is expected to impact on people’s health and on health services.

  • Level 4: National emergency. This is reached when a period of cold weather is so severe and/or prolonged that its effects extend outside health and social care, and may include, for example, transport or power or water shortages; and/or where the integrity of health and social care systems is threatened. At this level, illness and death may occur among the fit and healthy, not just in high-risk groups, and will require a multi-sector response at national and regional levels. The decision to go to Level 4 is made at national level by the Government.

Each alert level should trigger a series of indicative actions.

Cold Weather Alert messages will usually be cascaded throughout local communities. Local authorities will usually be responsible for doing this for social services, care homes and domiciliary care.

Alerts will appear on the Met Office website.

Responding to alerts

The issue of a Cold Weather Alert should trigger a series of actions by different organisations and professionals. These actions are specified in the Cold Weather Plan in a series of tables. In each area, local organisations are asked to consider the actions required and NHS, local authorities and local resilience forums are asked to assure themselves that appropriate local cold weather plans are in place.

The Government strongly encourages organisations and areas to take a system-wide approach and to refer to relevant guidance such as How to Reduce the Risk of Seasonal Excess Deaths Systematically in Vulnerable Older People to Impact at Population Level, published by the Department of Health.

Key points for domiciliary care providers are as follows.

  • At Level 0: Winter preparedness — long-term planning, providers are advised to:

    • ensure they are engaged with local emergency arrangements for winter planning

    • identify service users most vulnerable to cold weather and draw up plans for joined-up support with partner organisations

    • assess the implications of severe cold weather on business continuity plans

    • consider how to best mobilise and engage the local community if required.

  • At Level 1: Winter preparedness, providers are advised to:

    • ensure that Cold Weather Alerts are going to the right staff and that appropriate actions are agreed and implemented when received, especially to protect vulnerable patients and clients

    • work with partner agencies to co-ordinate plans

    • work with partners and staff on risk-reduction awareness (eg flu jabs for staff)

    • ensure that there is a business continuity plan in place for severe winter weather.

  • At Level 2: Severe winter weather — Alert and readiness, providers are advised to:

    • communicate alerts to staff

    • ensure locally agreed plans are implemented, especially those to protect vulnerable service users

    • ensure staff undertake appropriate home checks when visiting clients, eg room temperature, medications and food supplies

    • consider carers’ needs and the support they can continue to give

    • ensure rooms, particularly living rooms and bedrooms, are kept warm

    • activate business continuity arrangements and emergency plans as required.

  • At Level 3: Severe weather action, providers are advised to:

    • communicate alerts to staff and ensure that locally agreed plans are implemented, especially those to protect vulnerable service users

    • implement local plans for contacting the vulnerable

    • consider daily visits or phone calls for high-risk individuals living on their own who have no regular contacts

    • ensure carers are receiving appropriate advice and support

    • implement plans to deal with surge in demand

    • implement business continuity arrangements.

  • At Level 4: Major incident — Emergency response, providers are advised to maintain Level 3 actions and implement national emergency response arrangements.


From mid-November 2012, Winterwatch started to produce regular reports about the winter health situation and how the NHS is coping with the increased demands on its services.

Winterwatch, originally launched in 2010, is part of a wider suite of work by the Department of Health, such as the Cold Weather Plan, Keep Warm Keep Well, and the Warm Homes Healthy People Fund, that was designed to help protect people and keep them informed about the effects of severe winter weather.

Providers can sign up to get Winterwatch alerts when any new NHS data or flu updates are published.

Winterwatch can be found here on the DH website.

Helping service users to stay warm at home

Domiciliary care providers should ensure that they have appropriate staff training, policies, procedures and practices in place to protect vulnerable people from the dangers of cold weather. An important element of this is ensuring that staff are able to recognise where there might be a heating issue and advise service users about keeping their homes warm.

Before winter starts it is a good idea to check that the service user has adequate numbers of blankets and a backup heating plan, including emergency phone numbers for heating energy providers.

During cold weather staff should check on older or vulnerable people to make sure that:

  • they are safe and well

  • they are warm enough, especially at night

  • they have stocked up on food and medicines.

Help can also be encouraged from carers and neighbours.

In slippery conditions everyone, especially older people, should take extra care to avoid slips and falls. Older people and anyone with a health condition should try to stay inside if at all possible and make journeys outside only if they are essential.

Cold weather advice from the Government to those who are having problems heating their homes includes the following.

  • It can be harder to judge temperatures in older years; a thermometer at home may help.

  • Keep your main living room at 18–21°C.

  • Close bedroom windows at night and keep your bedroom at 18°C.

  • Use a hot water bottle or electric blanket to keep warm in bed if needed, but not at the same time.

  • Wear layers of clothing and shoes with good grip when outside.

  • Check on older neighbours and relatives to make sure they are safe.

General information on keeping safe and well when the weather is cold is given on the NHS Choices website.

The Get Ready for Winter campaign

The Government has started a campaign through the Met Office to encourage people to make preparations for winter conditions. Through the Met Office website people can access useful advice and watch out for the weather forecast and see any severe weather warnings issued for their part of the country.

The webpages give some suggestions for practical things that individuals and communities can do to prepare for a wide range of winter weather, including cold, ice and snow, high winds and flooding.

Warm Homes Healthy People

To support the aims of the Cold Weather Plan, the Department of Health has established the Warm Homes Healthy People Fund for winter 2012/13. The aim of the fund is to support local authorities and their partners in reducing death and morbidity in England caused by cold housing in the coming winter.

A total of £20 million is being made available for local authorities to fund the scheme. The money can be used to:

  • deliver energy efficiency and heating improvements to the most vulnerable people

  • provide people with benefits advice

  • ensure better public awareness of the impacts of cold weather

  • provide staff and volunteers with fuel poverty/cold weather awareness training.

Other grants and payments available include the Warm Front Scheme, Winter Fuel Payments and Cold Weather Payments. The Warm Front advisory service is a good place to start. The service is free and available on 0800 316 2805.


Both Cold Weather Plan for England 2012: Protecting Health and Reducing Harm from Severe Cold and the accompanying Cold Weather Plan 2012: Supporting the Case are available on the DH website.

Last reviewed 6 December 2012