Last reviewed 6 December 2021
Storm Arwen, which hit the UK in November, has already brought extreme winter weather this year, including high winds, snow and bitter cold. It left widespread disruption in its wake, including power cuts for large numbers of people. What are the risks to care provision during the winter months and what do providers have to do to ensure the safety of their staff and service users? Martin Hodgson investigates.
It is normal for the winter months to put added pressures on both health and adult social care services.
The negative effects of cold weather on health actually start at relatively moderate mean temperatures. Health problems such as heart attacks, strokes and lung conditions are all made worse in the winter while flu is always a serious seasonal risk. Other infectious diseases — such as the norovirus “winter vomiting” bug — also become more common as temperatures drop. This winter, the coronavirus (Covid-19) co-circulating with flu adds to the risks.
Freezing or stormy weather in particular can present serious problems for those in charge of care premises and for staff getting to and from work or visiting people in their homes. Heavy snowfall can bring travel misery and winter weather frequently causes power cuts and flooding.
Cold weather planning
In all parts of the UK, local authorities and health and social care providers must have winter contingency plans in place.
The Cold Weather Plan for England was published by the Department of Health. The plan is designed to raise people’s awareness of cold weather risks and sets out actions for local authorities, emergency services and for health and social care providers. It was updated in October 2021 ready for this winter.
North of the border, the Ready Scotland website contains essential information about coping with severe weather. In addition, the National Institute for Health and Care Excellence (NICE) has published guidance on excess winter deaths and illness and the health risks associated with people living in cold homes. This is particularly relevant for domiciliary care providers.
The Met Office 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 Public Health England. It comprises five levels.
Level 0: Year round planning.
Level 1: Winter preparedness, throughout the winter from November to March.
Level 2: Alert and readiness, declared when the Met Office predicts mean temperatures of 2°C and or widespread ice and heavy snow.
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.
Service providers should monitor the Met Office site whenever cold weather is expected. Warnings will also usually be cascaded through local authorities.
Red, amber, yellow, green warnings are issued depending on a combination of both the likelihood of severe weather and the impact the it may have.
Responding to Alerts
Care service providers should ensure that they are aware of both national action plans and local cold weather resilience plans.
The Cold Weather Plan for England sets out the following actions.
Level 0: Throughout the year care providers are advised to:
carry out year-round planning to build resilience and reduce the impact of cold weather
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, addressing fuel poverty, signposting for winter warmth initiatives, etc).
Level 1: Winter preparedness requires providers 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.
Level 2: Where 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 in care homes and in the community
activate business continuity arrangements as required
plan for surge in demand
consider prioritising those most vulnerable and provide advice as appropriate
check room temperatures.
Level 3: Where the severe weather predicted in Level 2 actually happens providers are advised to:
continue level 2 actions
implement emergency and business continuity plans
expect surge in demand in near future and prioritise the most vulnerable service users.
Level 4: If a national emergency or major incident is declared by the Government, a multi-sector response at national and regional levels will be required — care providers should:
maintain Level 3 actions.
Working closely together in partnership with local authorities, NHS and emergency services is probably the key message in very severe cold weather.
Helping Service Users to Stay Warm
Both residential and domiciliary care providers should ensure that they have appropriate staff training, policies, procedures and practices in place to protect vulnerable services users from the cold during the winter.
The Cold Weather Plan for England recommends indoor temperatures of at least 18°C (65F) 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 the temperatures overnight for “at-risk” people.
In care homes, managers should check that adequate heating arrangements are in place. Boilers should be serviced in good time for winter and checks should be made that all radiators are working effectively and are properly bled. Thermostats and controls should be adjusted as required to ensure that both bedrooms and communal areas are kept warm and comfortable. Staff should monitor room temperatures. Contingency arrangements should be made for emergencies such as power failures. For instance, a supply of spare blankets should be kept and the care home manager should keep emergency phone numbers for heating energy providers.
Heating maintenance should include a review of ventilation to ensure that buildings are safe from any carbon monoxide build up in the winter.
In domiciliary care, service users who might be vulnerable during cold weather should be identified and measures taken in partnership with other relevant agencies to mitigate risks. For instance, service users living in substandard accommodation may be referred to have housing improvements carried out. Research suggests that frail people living in cold or damp homes that are difficult to heat may be at real risk during a severe winter. Also vulnerable are “fuel poverty” victims who may be unable to afford to heat their homes adequately.
During extreme cold weather, staff in both residential and home care should check on vulnerable service users to ensure they are warm enough. Service users should be encouraged to keep active, to wear warm clothes and to have plenty of hot food and drinks.
In severely cold or slippery conditions everyone should be advised to take extra care. Older or frail service users should be advised to stay inside during the coldest weather and only make trips outside if essential. If they go outside they should be encouraged to wear appropriate warm clothing and footwear.
Flu and Covid-19
Flu is a danger every winter and this year there is also the risk of Covid-19 co-circulating with flu and causing more severe illness. All service users eligible for a free flu or Covid-19 vaccination should be encouraged to have one. This includes a Covid-19 “third jab” or booster dose made available to all adults in order to increase their levels of protection through the winter.
This year the free flu vaccination is available for all previously eligible groups, including primary school children, 65-year-olds and over, vulnerable groups and pregnant women. In addition, eligibility has also been extended to include secondary school children and 50–64-year-olds. Care providers should ensure that all their staff are offered a flu jab.
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.
Premises in flood prone areas are obviously at risk of damage and evacuation during severe flooding. However, flooding can also cause other problems. For instance, stopping care staff getting to work or, in the case of home care, reaching service users.
All care providers should have back-up staffing arrangements ready in case people cannot get to work. Managers should monitor the situation during periods of bad weather and look out for flood warnings.
In England these can be obtained from the Environment Agency online at www.gov.uk/check-if-youre-at-risk-of-floodinghttps://check-for-flooding.service.gov.uk/or via the national Floodline telephone service on 0845 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. This will send flood warnings automatically by text or email.
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.
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
ensure the home has the right insurance cover for damage and business interruption.
Employees should be trained so they know what to do in the event of a flood emergency.
In addition to keeping heating systems working efficiently, care home managers must also ensure that essential premises maintenance jobs are done. Severe winter weather can be very damaging for properties and may exacerbate existing problems, especially those related to damp and water damage.
Essential maintenance for winter preparedness includes fixing a leaking roof and clearing gutters and blocked downpipes. In the winter these can all be responsible for water seeping into buildings, especially as snow piled on roofs melts. At ground level consideration should be given to clearing gullies, drains, ditches and soak-aways. Blockages in ground water drainage can easily contribute to local flooding during storms.
Checking that water pipes are suitably insulated can help prevent them from freezing. Also important for the winter is a review of fire warning systems.
Safe access to a care home site during winter should be provided by maintaining car parks, pathways, entrances and steps. Autumn leaves should be cleared and stocks of grit and rock-salt obtained for dealing with ice build-up on walkways. External lighting should also be checked. Premises maintenance staff will need warm, waterproof high-visibility outside clothing, snow shovels and flashlights.
The latest Cold Weather Plan for England can be downloaded from the GOV.UK website.