Reducing harm from cold weather - Local government's new public health role

Reducing harm from cold weather - Local government's new public health role
Reducing harm
from cold weather
Local government’s new public health role
Reducing harm from cold weather - Local government's new public health role
Public Health has become the responsibility
    of local government. This briefing for
    councillors and officers explains the
    challenges facing councils and the
    opportunities they have to help to reduce
    harm to health from cold weather through
    effective, year round cold weather planning.

Introduction                                        3

Local government’s new role                         5

Core planning elements                              6

Is there a role for council scrutiny?               9

Five key messages for councils                     10

Key questions to ask                               12

Tools and resources                                13

Examples of local authority schemes                15

2      Reducing harm from cold weather
Reducing harm from cold weather - Local government's new public health role

The effects of cold                                Why plan for cold weather?
weather on the health                              The Cold Weather Plan for England (CWP)
                                                   aims to prevent avoidable harm to health, by
Although winter weather and snow can be
                                                   alerting people to the negative health effects
fun for some, these weather conditions are
                                                   of cold weather, and enabling them to prepare
also associated with an increase in illness
                                                   and respond appropriately. The CWP also aims
and injuries. Cold weather increases the risk
                                                   to reduce pressure on the health and social
of heart attacks, strokes, lung illnesses, flu
                                                   care system during winter through improved
and other diseases. People slip and fall in
                                                   anticipatory actions with vulnerable people.
the snow or ice, sometimes suffering serious
injuries. Some groups, such as older people,       The plan sets out a series of actions to be
very young children, and people with serious       taken by local authorities, the NHS, social
medical conditions are particularly vulnerable     care and other agencies throughout the year,
to the effects of cold weather.                    to prepare for and respond to winter, so as to
                                                   protect the vulnerable. It also encourages local
In 2011/12 there were 22,960 more deaths in
                                                   communities to support the most vulnerable in
England between the months of December
                                                   their area, such as checking on them during
2011 to March 2012 than were observed
                                                   severe weather and offering other support.
during the non-winter months. Excess deaths
are not just deaths of those who would have        It is clear that whilst actions taken by health
died anyway in the next few weeks or months        and social care sector during cold weather
due to illness or old age. There is strong         may relieve part of the health burden, the
evidence that some of these winter deaths          CWP is only part of a wider response required
are indeed ‘extra’ and are related to cold         to tackle excess winter deaths (EWDs) and
temperatures and living in cold homes as           there is a strong argument for a multi-agency
well as infectious diseases such as influenza.     approach to reducing the wider determinants
In the recent past, the rate of winter deaths in   of winter deaths and disease such as
England was twice the rate observed in some        socioeconomic inequalities, fuel poverty
northern European countries, such as Finland.      and housing energy efficiency.
Although there are several factors contributing    This is not something that can be tackled
to winter illness and death, in many cases         inthe winter alone and requires a long-term
simple preventative action could avoid many        strategic approach by health and wellbeing
of the deaths, illnesses and injuries associated   boards, directors of public health and
with the cold. Many of these measures need         commissioners to assess needs and to
to be planned and undertaken in advance of         commission, plan and implement interventions.
cold weather.

                                                             Reducing harm from cold weather      3
The Public Health Outcomes Framework              and EWDs. However, action to reduce the
(PHOF) sets out desired outcomes and              harm from cold can be linked to many more
indicators to help local authorities and their    outcome framework indicators connected
partners understand how well public health        to the wider determinants of health, such as
is being improved and protected. There            poverty, educational achievement and social
are two indicators within the framework that      connectedness.
are directly related to this plan: fuel poverty

Figure 1: PHOF indicators linked to action to reduce harm from cold weather

Outcome 1) Increased healthy life expectancy
Outcome 2) Reduced differences in life expectancy and healthy life expectancy between communities

1. Improving the           2. Health              3. Health Protection    4. Reducing Premature
wider determinants         improvement                                    Mortality
of health                                         3.3 Population
                           2.1 Diet               vaccination coverage    4.3 Preventable Mortality
1.1 Children in poverty
                           2.23 Self reported     3.6 Public Sector       4.4
Local government’s new role

Councils have had a long-standing role in         Co-ordinated multi-agency long term planning
reducing harm from cold weather, particularly     and commissioning for cold weather is
through the provision of social care to           essential to:
vulnerable individuals, housing assessment
and provision, and road gritting.                 • protect people and infrastructure from the
                                                    effects of cold weather and thus reduce
However, upper tier and unitary authorities         excess winter illness and death and the
have also become responsible for population         burden on health and social care;
health outcomes, under the terms of the Health
                                                  • support improved building design and
and Social Care Act 2012. They have a duty
                                                    increased energy efficiency which can
to ensure that plans are in place to protection
                                                    improve and protect health, reduce carbon
the health of their populations including
                                                    emissions, and generate jobs in the local
preparation for cold weather, snow and ice.
This is backed by a ring-fenced public health
grant and a specialist public health team, led    • tackle fuel poverty; including energy
by the director of public health and supported      efficiency interventions in the home,
by Public Health England.                           minimising energy costs, and maximising
                                                    household income.
Chief executives of local authorities and
councillors, especially those with portfolio
responsibility for health, have important
strategic overview and scrutiny functions,
as well as community engagement and
decision-making roles.

Each top tier and unitary authority also has
a health and wellbeing board which will
have strategic influence over commissioning
decisions across health, social care and
public health.

                                                            Reducing harm from cold weather      5
Core planning elements

    Strategic planning and commissioning:
    • Co-ordinated and multiagency planning and commissioning throughout the year,
      to protect people and infrastructure

    Alert system (advance warning and advice):
    • a Cold Weather Alert system, which operates from 1 Nov – 31 March based on
      Met Office forecasts and triggers levels of response from the NHS, local government
      and the public health system and communicate risks to the public (illustrative actions
      for local authorities in figure 2)

    Preparedness and action:
    • planning and response to risks of cold weather, snow and ice including action to reduce
      exposure to low indoor temperatures, care for vulnerable groups, preparedness of the
      health and social care system and business continuity

    Communicating with the public:
    • a local cold weather health information plan including public health messages
      and resources such as the Keep Warm, Keep Well booklet

    Working with service providers:
    • supporting provider organisations and their staff to reduce cold-related harm, and raising
      awareness of toolkits, best practice and referral mechanisms for winter warmth initiatives

    Engaging the community:
    • engaging community and voluntary sector organisations, which may offer significant
      assistance in identifying and supporting particularly vulnerable or marginalised individuals

    • monitoring of health impact and evaluation of response

6       Reducing harm from cold weather
Figure 2: Action Table: Commissioners of health and social care (all settings) and local authorities

                                   Level 0                         Level 1                     Level 2                      Level 3                       Level 4
                                   Long-term planning              Winter preparedness         Severe winter weather        Severe weather action         Major Incident –
                                   All Year                        and action                  is forecast - Alert and      Mean temperatures of          Emergency response
                                                                   1 November – 31March        readiness                    2°C and/or widespread
                                                                                               Mean temperatures of 2°C     ice and heavy snow
                                                                                               and/or widespread ice and
                                                                                               heavy snow is predicted
                                                                                               with 60% confidence
                                   Work with partner               Communicate public          Continue to communicate      Continue to communicate       Central Government will
                                   agencies to ensure that         health media messages       public health messages       public health messages        declare a Level 4 alert
                                   Cold Weather Planning           (see Executive summary).                                                               in the event of severe or
                                   features within wider winter                                Communicate alerts to        Communicate alerts            prolonged cold weather
                                   resilience planning.            Consider the revisions      staff and make sure that     to staff and make sure        affecting sectors other
                                                                   to the 2013 CWP and         they can take appropriate    that winter plans are         than health.
                                   Work with partners              ensure that the changes     actions                      in operation
                                   to ensure a strategic           are understood across the                                                              Response likely to involve:
                                   approach to the reduction       system. Work with partner   Ensure partners, including   Ensure key partners are
                                                                                                                                                          • develop a shared
                                   of EWDs and fuel poverty        agencies to co-ordinate     all managers of care,        undertaking action in
                                                                                                                                                            understanding of EWDs
                                   is taken across the local       locally appropriate cold    residential & nursing        response to alerts
                                                                                                                                                            and what partners can
                                   health and social care          weather plans.              homes are aware of the
                                                                                                                            Support local community         do to reduce them.
                                   economy                                                     alerts and can access
                                                                   Ensure key partners,        advice.                      organisations to mobilise
                                                                                                                                                          • National Government
                                   Work with partner               including all managers                                   community emergency
                                   agencies to:                    of care, residential and    Support local community      plans
                                                                   nursing homes are aware     organisations to activate                                  • Executive Agencies
                                   • develop a shared                                                                       Ensure continuity
                                                                   of the alert system and     community emergency
                                     understanding of EWDs                                                                                                • Public Sector, including
                                                                   can access advice.          plans                        arrangements are working
                                     and what partners can                                                                                                  health sector
                                                                                                                            with provider organisations
                                     do to reduce them.                                        Activate business
                                                                   Review the distribution                                                                • Voluntary Sector
                                   • identify those most at risk   of the alerts across the    continuity arrangements
                                     from seasonal variations      system and ensure staff     and emergency plans as
                                                                   are aware of winter plans   required
                                   • improve winter resilience
                                                                   and advice
                                     of those at risk

Reducing harm from cold weather
                                  Level 0                       Level 1                        Level 2                      Level 3                      Level 4
                                  • ensure a local, joined-up   Ensure that local              Consider how to make best    Work with partner            All level 3 responsibilities
                                    Programme is in place       organisations and              use of available capacity,   agencies (eg transport) to   must be maintained during
                                    to support improved         professionals are taking       for example by using         ensure road / pavement       a level 4 incident
                                    housing, heating and        appropriate actions in light   community beds for at risk   gritting arrangements are
                                    insulation, including       of the cold weather alerts     patients who do not need     in effect to allow access    Implementation of national
                                    uptake of energy            in accordance with local       an acute bed and enabling    to critical services and     emergency response
                                    efficient, low carbon       and national CWP.              access to step- down care    pedestrian hotspots          arrangements by central
                                    solutions                                                  and reablement                                            Government
                                                                Ensure that organisations
                                  • achieve a reduction in
                                                                and staff are prompted to      Work with partner
                                    carbon emissions and
                                                                signpost vulnerable clients    agencies (eg transport) to
                                    assess the implications
                                                                onwards (eg for energy         ensure road / pavement
                                    of climate change
                                                                efficiency measures,           gritting preparations are

Reducing harm from cold weather
                                                                benefits or related advice)    in place to allow access
                                  Consider how your winter
                                                                                               to critical services and
                                  plans can help to reduce
                                                                Liaise with providers of       pedestrian hotspots.
                                  health inequalities,
                                                                emergency shelter for
                                  target high risk groups
                                                                homeless people to agree
                                  and address the wider
                                                                plans for severe weather
                                  determinants of health
                                                                and ensure capacity to
                                                                scale up provision.
                                  Ensure that organisations
                                  and staff are prompted to
                                                                Support communities to
                                  signpost vulnerable clients
                                                                help those at risk. Support
                                  onwards (eg for energy
                                                                the development of
                                  efficiency measures,
                                                                Community Emergency
                                  benefits or related advice)
                                  Work with partners and
                                                                Identify which local health,
                                  staff on risk reduction
                                                                social care and voluntary
                                  awareness (e.g. flu
                                                                sector organisations
                                  vaccination for staff in
                                                                are most vulnerable to
                                  Sept/Oct), information and
                                                                the effects of winter
                                                                weather. Agree plans for
                                                                winter surge in demand
                                  Engage with local CVS
                                                                for services. Make sure
                                  organisations for planning
                                                                emergency contacts are
                                  and implementation of all
                                                                up to date.
                                  stages of the plan.
Is there a role for
council scrutiny?

Some councils have carried out scrutiny             Council scrutiny can play an important role
reviews focussing on preparedness for               bringing together public agencies and civil
winter pressures on health services (such as        society organisations to establish the extent to
accident and emergency services) and road           which these issues are prevalent in local areas
gritting during freezing conditions. Whilst these   and to ask questions about planning for better
are important topics, falling levels of family      outcomes from services.
incomes, rising levels of fuel poverty and
isolation of older people and means that the
effects of cold weather can be hidden.

                                                              Reducing harm from cold weather      9
Five key messages
for councils

In light of the guidance and good practice          4. The community and voluntary sector can
recommendations made in the Cold Weather               help reduce vulnerability and to support
Plan 2013, there are five key messages for             the planning and response to cold weather,
all areas:                                             particularly through identifying and engaging
                                                       vulnerable people. NHS and local authority
1. All local authorities, NHS commissioners            commissioners and providers, should take
   and their partner organisations should              opportunities for closer partnership working
   consider the Cold Weather Plan 2013                 with these groups.
   and satisfy themselves that the suggested
   actions and the Cold Weather Alert service       5. Reducing excess winter illness and death
   are understood across their locality.               is not something that can be tackled in
   Local cold weather and winter plans                 the winter alone. It requires a long-term
   should be reviewed in light of this plan.           strategic approach by health and wellbeing
                                                       boards, directors of public health and
2. NHS and local authority commissioners               commissioners to assess needs and
   should review or audit the distribution of          the commission, plan and implement
   the Cold Weather Alerts across the local            interventions. Action to reduce cold-
   health and social care systems to satisfy           related harm should be considered core
   themselves that the alerts reach those              business by health and wellbeing boards
   that need to take appropriate actions,              and included in Joint Strategic Needs
   immediately after issue. Figure 3 is an             Assessments (JSNAs) and Joint Health \
   illustrative diagram showing a cascade              and Wellbeing Strategies (JHWSs).
   of a Cold Weather Alert message. Local
   areas need to adapt these to their particular
   situations and ensure themselves that the
   cascades are working appropriately.

3. Local authority commissioners should assure
   themselves that organisations and key
   stakeholders are taking appropriate actions
   in light of the Cold Weather Alert messages.
   The actions identified in figure 2 are based
   on the best evidence and practice available,
   but are illustrative. It is for local areas to
   amend and adapt this guidance and to
   clarify procedures for staff and organisations
   in a way which is appropriate for the local
   situation. As ever, it is for professionals
   to use their judgement in any individual
   situation to ensure that they are doing
   the best they can for their patient or client.

10    Reducing harm from cold weather
Figure 3:Typical cascade of cold weather alerts

   Winter                   Civil                                                     Public,
 Resilience            Contingencies                                                via media
                         Secretariat                                              e.g. TV, radio,
                         Department                                                newspapers
                       of Health Other             Met Office
                        Departments               Cold Weather
                        and Agencies                  Alert

                                                                                  Public Health
     Prisons                                                                        4 Regions
                                                                                  15 PH Centres

                                                                                Social Services
                              England              Local Authority
                                                  (CE/ DASS/DCS/               Day care centres
                          Corporate Team                                          Residential
   NHS Choices                                        and Directors
                            (National)              of Public Health              homes and
                                                  Inc. Local Resilience        children’s homes
 Ambulance trusts         Regional Teams               (and Local
                                                    Health Resilience
                                                                                 Schools and
                            Area Teams

                                                                              Children’s centres
     GPs and
  District Nurses
  Hospital trusts

                                                                               Winter warmth
  Walk in centres                                                              advice services
 Community health          Groups (CCGs)
 service providers
                                                   Health and
   Mental health
      trusts                                        Boards

                                                             Reducing harm from cold weather        11
Key questions to ask

• What are our current levels of excess winter     • Is there an explicit approach to data sharing
  deaths and/or fuel poverty and how do              between agencies? Does this enable
  they compare with similar local authorities/       vulnerable people in cold housing to be
  England average? Are there particular              able to access support, whilst respecting
  populations/areas within your locality where       information governance requirements?
  there are high levels of excess winter deaths
                                                   • Are messages about the impact of cold
  and/or fuel poverty and what is being done
                                                     weather and cold homes simple and
  to support them?
                                                     inclusive? This is likely to increase the
• Does the JSNA and JHWS include                     uptake of interventions; especially with
  excess winter deaths and/or fuel poverty?          those who do not identify themselves as
  Are excess winter deaths and/or fuel poverty       being vulnerable to cold.
  considered commissioning priorities?
                                                   • Is there a good structure in place to achieve
• Is there a local, multiagency cold weather         oversight, monitoring and co-ordination
  plan in place and has it been reviewed             of services to reduce the impact of cold
  recently in light of the changes to the health     weather, across the health, social care and
  and social care system? Are all those              public health systems?
  who need to receive cold weather alerts
                                                   • Have you defined what success looks like
  receiving them and do they know what to
                                                     in your local area? Are there arrangements
  do in response?
                                                     in place to provide regular reports about
• Are services focused on prevention and long        progress? Is this being fed back to the
  term planning and interventions, rather than       health and wellbeing board?
  only focussing on reactive action once a
  cold snap arrives?
• What measures are in place to ensure the
  most vulnerable are identified and targeted
  for interventions? Have you thought about
  how to engage vulnerable groups who may
  not be known to statutory services?

12    Reducing harm from cold weather
Tools and resources

The Cold Weather Plan builds on existing            local organisations communicate with the
programmes and public health measures               public.
to protect individuals and communities              publications/keep-warm-keep-well leaflet
over the winter period.                             gives advice on staying healthy in cold
The key elements include:
                                                  • NHS Choices (
                                                    The main NHS website provides reliable
• Annual seasonal influenza (flu)
                                                    advice and guidance throughout the year
  vaccination programme
                                                    on how to keep fit and well. It includes
                                                    information on topics such as: keeping
                                                    warm; the dangers of carbon monoxide
  This aims to protect people from the              poisoning; the importance of eating well;
  harmful effects of flu and is offered,            and the symptoms of flu. The site also offers
  free of charge, to certain at-risk groups.        symptom checkers and details of all local
  The national NHS staff seasonal flu               health services.
  vaccination campaign website can be
                                                  • NHS winter pressures reporting and
  found at:
                                                    winter resilience programmes. These are
                                                    plans made locally and nationally over the
                                                    winter to help the NHS and local agencies
  and @NHSFlufighter
                                                    to manage the demands placed on essential
• Pneumococcal vaccination programme                services so they can continue to operate
  which aims to protect those people most           smoothly through severe winter weather.
  at risk from pneumococcal disease which           NHS England will, each week, post on their
  can cause meningitis, septicaemia and             website information for service professionals
  pneumonia.                                        and users about the current volume of
• Stop norovirus spreading this winter              activity in response to the winter pressures,
  – leaflet. This downloadable poster for           including regular data on A&E and
  health professionals contains information         ambulance activity. http://www.england.nhs.
  about norovirus, how it’s transmitted             uk/2013/11/15/winter-hlth-chk/
  and advice how to prevent spreading
                                                  • Winter Health Watch – this is PHE’s
  the disease.
                                                    webpage for information on winter health
                                                    surveillance including syndromic, influenza,
                                                    norovirus and mortality surveillance
• Keep Warm Keep Well This provides                 reports
  advice on staying warm over the winter and        organisations/public-health-england/series/
  checking on neighbours and relatives who          winter-health-watch
  may be vulnerable during cold weather, in
  order to reduce illness and deaths. Materials
  will continue to be available online to help

                                                            Reducing harm from cold weather    13
• Excess Seasonal Deaths Toolkit – this was        • NEA, as a member of the Age Action Alliance
  produced by the Department of Health to            and in conjunction with DECC and British
  help local communities take a systematic           Gas, is offering free energy awareness
  approach to reduce the risk of seasonal            sessions across England, following
  excess deaths in older people. http://             successful pilot workshops aimed at training­          older people and practitioners working with
  seasonal-access-deaths.pdf                         them to become advocates for home energy
                                                     efficiency. Sessions are designed to promote
• Excess Winter Deaths Atlas for England
                                                     warm and healthy homes messages and
  - information about excess winter deaths
                                                     include information on:
  produced by the Chief Knowledge Officer
  directorate at PHE, currently at:                • How to spot the signs of a cold home and                the impact of cold homes for older people
  inEnglandatlas/, pending migration to
                                                   • How to prepare for colder weather
  PHE website
                                                   • Extra help available from energy companies
• Warm Homes, Healthy People fund:
                                                     for older householders
  keeping people warm in winter – this is
  was an initiative where funds were made          • Heating and insulation schemes including
  available for winter 2011-12 and winter            Green Deal and the Energy Company
  2012-13 to support local authorities and their     Obligation; and more.
  partners in reducing death and morbidity in      • For full details and more information on how
  England due to cold housing in the coming          to book a session, visit the NEA website
  winter. Information about individual schemes
  and examples of good practice are available
  in the two evaluation reports and on the         The Equinox leaflets (http://www.equinoxcare.
  LGA knowledge hub.­ developed by service
  Weather-Publications                             users with help from medical staff, particularly:
                                                   • Alcohol and extreme cold weather
  goodpractice/welcome./                           • Drugs and extreme cold weather
                                                   • Mental ill health and extreme cold weather
• Get Ready for Winter Campaign – this
  is an annual web-based campaign hosted
  by the Met Office and is a portal for
  government departments and their partners.
  The pages offer advice and links to a range
  of organisations to help individuals, families
  and communities prepare for winter.­

14    Reducing harm from cold weather
Examples of local
authority schemes

Examples of the innovative work being done       Merton Council
by councils across the country to help the       London Borough of Merton Council has been
vulnerable this winter.                          installing free temperature sensors across
                                                 many homes of their existing MASCOT
Surrey County Council                            Telecare customers. The sensors can detect
Surrey County Council has enlisted 50 farmers    if the temperature in a home drops below
with ploughs to support its existing highways    16C (60F) which will then raise an alert on the
teams and they have joined forces with the       system at a 24-hour monitoring centre, allowing
Salvation Army and the South East 4x4 club,      operators to take the necessary action.
whose 90 volunteers will use their vehicles to
help the council reach vulnerable people in
critical need of social care and health visits   health/mascot.htm
during the bad weather.
                                                 Blackburn with Darwen Council­           Blackburn with Darwen Council ‘Decent and
community/emergency-planning-and­                Safe Homes’ service provides advice on how
community-safety/preparing-for-winter/how­       to keep homes warm while keeping energy
our-highways-team-is-preparing-for-winter        bills down as well as offering a free handyman
                                                 service for residents aged over 60 or those
Chichester District Council                      getting disability living allowance. Winter squad
Vulnerable residents in Arun and Chichester      is a voluntary led project supported by the
can request a fee home energy visit where        Council under the “Your Call” campaign.
an expert will show them how to use heating      Local groups of volunteers each form a winter
controls effectively and share tips on how to    squad in order to look after the more vulnerable
keep warm and save energy in their homes.        in their local area and to help keep shared
                                                 public areas free of ice and snow during an              extended cold snap.

                                                           Reducing harm from cold weather      15
Lewisham Council                                  Stockton-on-Tees Council
London Borough of Lewisham Council has            Stockton-on-Tees Borough Council has
a number of initiatives in place including its    published a leaflet sent to thousands of
‘Help at Home’ service to meet the acute and      residents, as part of its regular magazine,
immediate needs of 400 of the borough’s           about winter and council services, including
most vulnerable residents this winter. Older      how to clear pavements, drive in snow and
people, social care and health professionals      the locations of its 300 grit bins. It’s geared
and other concerned individuals will be able      up to issue daily online and media bulletins
to refer someone directly into the service to     about gritting works, school closures, weather
access critical care services. The council        forecasts and where to get salt, and will
is also working in partnership with Age UK        also be putting out regular tweets and
and Lewisham Pensioners Forum on the ‘End         Facebook updates.
Loneliness’ campaign to identify isolated older
people in the community and introduce them to
the support networks available.                   emergencyadvice/coldweatheradvice/           There are a series of case studies from
environment/energyefficiency/energy­              local authority schemes documented in the
efficiency-projects/Pages/Getting-ready-for­      evaluation reports of the Warm Homes Healthy
winter.aspx                                       People Fund 2012-13 and 2012-13.

16    Reducing harm from cold weather

        Reducing harm from cold weather   17
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