Every year health and adult social care service providers have to cope with the effects of cold weather. What are the risks of winter weather and what do adult social care providers have to do to ensure the safety of their staff and service users? Martin Hodgson investigates.
Winter is a busy time for UK health and social care services. Cold weather can have a serious impact on the health of many people, particularly older or vulnerable people, and is responsible for many deaths and illnesses each year.
Influenza is a particular risk, and other infectious diseases, such as Norovirus — the winter vomiting bug — put health and social care organisations under great strain. Health problems such as heart attacks, strokes, lung illnesses, flu and other diseases are made worse in the winter, and an increase in accident rates also puts pressure on the NHS, particularly A&E departments. People slip and fall in the snow or ice, sometimes suffering serious injuries, and power cuts, severe snowfall and floods can also bring misery and disruption.
Cold weather planning
In all parts of the UK, local authorities and health and social care providers are encouraged to have contingencies in place to cover winter risks.
Guidance is provided by the Public Health England (PHE) who published an updated version of its Cold Weather Plan for England in October 2018.
The plan is intended to raise awareness of cold weather risks, particularly among those who care for older or more vulnerable people, and provides guidance on how to prepare for and respond to cold weather. It provides advice for individuals, communities and agencies and encourages a “system-wide” approach.
Importantly, the plan states that the response of health and social care organisations to protect vulnerable people should not only occur during what is considered “extreme” winter weather. PHE points out that, in an average winter, most of the health burden attributable to cold occurs at relatively moderate mean outdoor temperatures (from 4–8°C depending on region). The plan therefore recommends a year-round approach.
North of the border, the Ready Scotland website contains essential information about coping with severe weather. In Wales, a Choose Well campaign was introduced in November 2018 supported by a My Winter Health Plan pack aimed at helping people with long-term physical or mental health conditions.
These various winter planning strategies are supported by guidance from the National Institute for Health and Care Excellence (NICE). Preventing Excess Winter Deaths and Illness Associated with Cold Homes is a guideline and quality standard published to raise awareness of the problems faced by people living in the community in unmodernised housing that is hard to heat. It also draws attention to the problems of people living in “fuel poverty” who cannot afford adequate heating.
All planning guidance agrees that multi-agency co-operation is key for the protection of vulnerable groups in winter.
At risk groups
Cold temperatures predominantly affect older age groups, children and those with chronic illnesses. Contingency planning is therefore primarily targeted at these groups.
PHE estimates that about 40% of cold-related mortality is due to cardiovascular disease and 33% to respiratory disease.
Met Office alerts
Cold weather plans and contingencies in different parts of the country are supported by cold weather alert services run by the Met Office.
The Met Office’s National Severe Weather Warning and Cold Weather Alert services underpin all cold weather plans and help to give service providers early warning of problems ahead.
The Cold Weather Alert service works in collaboration with PHE. It comprises five levels.
Level 0: Year-round planning.
Level 1: Winter preparedness, in force throughout the winter from November to March.
Level 2: Alert and readiness, 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.
Level 3: Severe weather action, issued when the weather described in level 2 actually happens.
Level 4: National emergency, 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.
Alerts appear on maps on the Met Office website.
The warnings are given a red, amber, yellow, green colour depending on a combination of both the likelihood of the event happening and the impact the conditions may have.
Service providers should monitor the Met Office site for warnings, which will also usually be cascaded through local authorities.
Responding to alerts
Service providers throughout the UK should ensure that they are aware of both national action plans and local resilience plans for cold weather.
The Cold Weather Plan for England sets out the following actions.
At Level 0, throughout the year, care home providers are advised to:
ensure the organisation can identify and support the most vulnerable
plan for joined up support with partner organisations
work with partners and staff on risk reduction awareness (eg flu vaccinations, signposting for winter warmth initiatives).
At Level 1: Winter preparedness, providers are advised to:
ensure cold weather alerts are going to right staff and actions are agreed and implemented
ensure staff in all settings are considering appropriate room temperatures and helping service users to keep warm
ensure data sharing and referral arrangements in place.
At Level 2: Severe winter weather is forecast, providers are advised to:
continue level 1 actions
communicate alerts to staff
ensure locally agreed plans are implemented, especially those to protect vulnerable service users
activate business continuity arrangements as required
plan for surge in demand
consider prioritising those most vulnerable and provide advice as appropriate
check room temperatures and ensure urgent referral if necessary.
At Level 3: Severe weather action, providers are advised to:
continue level 2 actions
implement emergency and business continuity plans
expect a surge in demand in near future and prioritise the most vulnerable service users.
At Level 4: Major incident — emergency response, providers are advised to:
maintain level 3 actions and implement national emergency response arrangements.
Working closely together in partnership with local authorities, NHS and emergency services is probably the key message in very severe cold weather.
Helping care home residents to stay warm
Care home providers should ensure that they have appropriate staff training, policies, procedures and practices in place to protect vulnerable residents from the dangers of cold weather. An important element of this is ensuring that staff are able to recognise where there may be a heating issue and advise service users about keeping their rooms warm.
Key contingency planning actions for care home managers include the following.
Lists of emergency contact phone numbers for electricity, gas and water suppliers should be updated.
Heating equipment and boilers should be inspected and serviced as recommended by manufacturers.
A backup operating plan should be in place for power cuts.
A ready source of safe emergency lighting should be provided, including torches with batteries.
A stock of spare blankets and food and drink that can be easily heated in the event of power loss should be maintained.
Snow shovels and rock salt should be ready in case of icy conditions.
During cold weather, care staff should check on vulnerable residents to ensure they are warm enough, especially at night. Residents should be encouraged to keep active, to wear warm clothes and to have plenty of hot food and drinks. Staff should monitor room temperatures and ensure the care home is kept warm, particularly communal living rooms and bedrooms.
The Cold Weather Plan recommends indoor temperatures of at least 18°C (65°F) in winter. It states that this threshold is particularly important for people 65 years and over or with pre-existing medical conditions, and having temperatures slightly above this threshold for these people may be beneficial for health. It also recommends maintaining these temperatures overnight for at-risk people.
In slippery conditions everyone, especially older people, should take extra care to avoid slips and falls. Residents should be advised to stay inside during the coldest weather and only make trips outside if they are essential. If they go outside they should be encouraged to wear appropriate warm clothing.
Contingency plans in domiciliary care organisations will be broadly similar to those in care homes and will be designed to keep services running so that they can continue to provide support safely to people wherever possible during bad weather.
Domiciliary care managers and staff should do whatever they can to identify service users who may be at risk in cold weather and put into place measures to reduce risks. Staff who visit people at home should assess the heating needs of service users and refer anyone who needs help with the problems of living in a cold home to local housing support services, if they give their consent. Where a service user is identified as vulnerable, during cold weather, domiciliary care staff should consider what can be done to provide extra support. This may include additional visits to check they are keeping warm and have hot food and drink.
In cold weather, staff should advise service users to:
keep their heating turned on
draw curtains and keep bedroom windows closed at night
never cover heaters and fires, such as with drying clothes
never block air vents if they have wood-burning, coal or gas heaters
dress in plenty of layers of warm clothing
eat healthily and have regular hot drinks
keep a list of emergency numbers handy
ask friends or family to drop in.
Where necessary, home care workers might also liaise with a vulnerable person’s GP or with local charities and community support groups. For instance, Age UK runs an annual Spread the Warmth campaign which aims to distribute essential items to keep people warm such as clothes, heaters and electric blankets. For people who rely on food banks some charities will deliver food where vulnerable individuals are unable to get out of their homes because of the cold.
Sustained periods of cold and icy weather can disrupt travel and affect the ability of care staff to get to service users. In such cases, alternative ways of providing care may need to be put in place, including liaising with neighbours.
Flu is a danger every winter and all service users eligible for a free flu vaccination should be encouraged to have one through their GP.
Free flu vaccinations are available for a range of at-risk groups, including those who:
are aged 65 or older
have a serious medical condition such as chronic heart, lung, neurological, liver or kidney disease, or diabetes
have a weakened immune system
have had a stroke or transient ischaemic attack (TIA) or post-polio syndrome
are living in a long-stay residential care home or other long-stay care facility
are the main carer for an elderly or disabled person whose welfare may be at risk if they fall ill.
Wet and stormy winter weather inevitably raises the risks of flooding, both from rivers bursting their banks and from tidal storm surges and gales in coastal areas. Care providers should carry out appropriate assessments to determine flood risk and the possible impact on their service users and services.
Where a risk is identified to a care home, providers should:
ensure that buildings are designed and managed to be as safe from flooding as possible
put in place emergency plans for coping with both minor and major flooding disruption — these should include evacuation plans agreed with local authorities and emergency services
constantly monitor the situation during periods of bad weather and look out for flood warnings
ensure the home has the right insurance cover for damage and business interruption
have in place back-up staffing arrangements in case staff cannot get to work
train employees so they know what to do in the event of a flood emergency.
Managers of care services in flood risk areas should pay close attention to flood warnings.
In England, these can be obtained from the Environment Agency online or through the national Floodline telephone service on 0345 988 1188.
Flood warnings are issued as follows.
Severe flood warning (severe flooding — danger to life).
Flood warning (flooding is expected — immediate action required).
Flood alert (flooding is possible — be prepared).
Warning no longer in force.
An online interactive map is provided and managers can also register for the free flood warning service, Floodline Warnings Direct, which will send flood warnings automatically.
In Scotland, the Scottish Environment Protection Agency (SEPA) offers a similar service and in Wales flood alert services are the remit of Natural Resources Wales.
The latest Cold Weather Plan for England can be downloaded from the GOV.UK website.
Two public information leaflets are published by the Government to support the plan. Keep Warm, Keep Well provides information for over 60s, for low-income families and for people living with a disability. The Top Tips for Keeping Warm and Well leaflet refers people to the website at www.nhs.uk.
Severe weather guidance for Scotland can be found on the Ready Scotland website.
NICE guideline NG6, Excess Winter Deaths and Illness and the Health Risks Associated with Cold Homes, is available on the NICE website.
Last reviewed 21 January 2019