Guidance

Supporting vulnerable people before and during cold weather: for adult social care managers

Published 11 September 2023

Applies to England

Who this guidance is for

This guidance provides advice to managers working in the social care sector on how to reduce the risks of cold weather to the health and wellbeing of those who receive care. It is intended for managers of registered care homes and other residential settings, and for managers of providers that provide care in clients’ own homes.

Social care managers in these settings should also consult the Cold-Health Alert action card for providers. This card summarises the suggested actions that providers of social care should consider to prepare for and respond to each Cold-Health Alert (CHA) type (yellow, amber or red). It also identifies some of the key long-term strategic actions managers can take which will help minimise harms to health arising from cold weather. Find more information within about the Cold-Health Alert system about the CHAs.

Carers providing direct care to people, including in their own homes, are recommended to review UK Health Security Agency (UKHSA) guidance on keeping warm and well: staying safe in cold weather for advice on keeping buildings warm during periods of cold weather, and other general measures to help protect social care clients.

Main messages

Cold weather can put people at greater risk of ill-health and even death primarily because it increases the probability of complications from existing disease, and of injury due to falls.

In all settings, you should reduce the risks associated with exposure to cold weather by:

• developing, and where necessary implementing, business continuity plans (BCP) for cold weather, and ensuring all staff know how to take action accordingly
• protecting clients and staff by promoting COVID-19 and flu vaccination for them
• taking simple measures to protect clients and staff from cold, snow and/or ice

If you work in a setting that provides care in clients’ own homes, you should also:

• identify who is at higher risk of cold-related illnesses and how to reduce that risk
• have a plan in place for individuals you are responsible for to keep them warm during the winter and ensure staff know how to raise concerns regarding clients they are working with if necessary
• ensure staff are aware of main sources of support for housing, energy bills and other needs to signpost clients to, including support for those on low incomes

About cold weather and health

Deaths during the winter months are significantly higher than at other times of the year. The reasons for this are complex. Cold weather can cause people to become unwell in various ways:

• direct cold exposure can result in death or severe illness due to hypothermia, although deaths where hypothermia is the primary cause are rare
• exposure to cold can increase the risk of blood clots forming in the body, in turn increasing the risk of heart attacks and strokes
• cold exposure can also increase susceptibility to chest infections, worsen breathing problems and increase the risk of falls
• longer term effects include an increased risk of mental health conditions such as depression and anxiety

Many people with care needs have underlying health conditions that put them at greater risk from cold.

Cases of carbon monoxide poisoning among those living at home increase during the winter months. This is because people are more likely to use cooking or heating systems at home that worsen indoor air quality and are less likely to be able to ventilate their homes as they would during warmer weather.

Who is at risk

Many people who use adult social care services are vulnerable to the effects of cold weather. Those at risk include:

• older people (aged 65 years and over)
• people with cardiovascular (heart and circulation) conditions
• people with respiratory conditions (in particular, chronic obstructive pulmonary disease and childhood asthma)
• people with mental health conditions
• people with learning and/or physical disabilities
• young children (particularly those aged under 5 years)
• pregnant women
• people on a low income

Other factors may increase risks from cold weather for people in the groups listed above. These include living in homes that are hard to heat (for example, with broken or draughty doors and windows), homes that rely on traditional heating methods (for example, storage heaters), or that are in high-rise apartment blocks.

How to prepare for cold weather

Managers should carry out preparation work for cold weather year-round. Social care provider organisations should agree plans for managing cold weather events and distribute them to social care managers and frontline staff before 1 November each year. An action card for health and social care providers can be found on GOV.UK.

Actions to take all year round

In preparation for winter, there are actions you can take depending on your role.

In all settings, you should:

• consult the action card for providers to identify actions to support year-round planning, and distribute this information where relevant to your teams
• ensure data sharing agreements or protocols are in place to allow data and intelligence to be shared, including details of the most vulnerable people where appropriate
• develop business continuity plans to prepare for disruptions caused by adverse cold weather, including energy supply and transport problems, and staff shortages. These plans should include contact details for reporting any concerns to the local authority and other relevant partners (for example in the event of disruptions to heating supplies)

If you work in a care home or other residential setting, you should:

• draught-proof windows, doors and other points of energy loss
• ensure heating systems are maintained and in good working order

If you work in a setting that provides care in clients’ own homes, you should:

• establish methods for staff to identify, alert and monitor individuals most vulnerable to cold-related illnesses on your service caseload
• identify local sources of support for clients that may be available if cold weather occurs, through discussion with the local authority, local resilience forum (LRF) and other partners
• develop a training plan for staff to help them identify those most likely to be at risk from cold weather and advise on how to raise concerns where necessary, drawing on established resources such as UKHSA’s helping people living in cold homes e-learning module

Actions to take during the winter months

To prepare for cold weather, there are certain actions you should take: protect those at risk; and support staff.

Protect those at risk

In all settings, you should:

• consult the action card for providers to identify actions to support pre-winter readiness, and distribute this information where relevant to your teams
• promote vaccination for COVID-19 and/or flu among those who are eligible, to help reduce risks from respiratory infections during the winter
• identify points of higher risk of injury to safeguard access to critical services in the event of ice and/or snow, such as at entrances and exits, and prioritise these for clearance or gritting when snow and/or ice occur – this would include ensuring adequate supplies of relevant equipment (such as shovels and gloves)

If you work in a care home or other residential setting, you should:

• ensure that plans are in place to be able to monitor room temperature, body temperature, pulse rate and blood pressure to protect residents

If you work in a setting that provides care in clients’ own homes, you should:

• ensure that staff members have identified all those vulnerable to cold weather and that arrangements are in place to support and protect them appropriately – this assessment process should take place at least annually, and may include developing and maintaining a register of the most vulnerable individuals to ensure they can be offered appropriate support where required
• ensure plans and equipment are in place to enable staff members to carry out appropriate home checks when visiting clients – this should include, for example, room temperature assessments, checking medications stocks and ensuring adequate food supplies are available

Support staff

In all settings, you should:

• protect yourself and your staff by encouraging vaccination for COVID-19 and/or flu as a preventive measure to reduce the risk of respiratory infections during winter. Staff can check eligibility for flu vaccination and book an appointment through occupational health services, their pharmacy or GP. For COVID-19, NHS England will contact those eligible
• ensure that you cascade BCPs and/or cold weather plans to relevant members of staff, and that they understand how to implement them
• test out local dissemination systems for CHAs to make sure they are fully operational and that staff understand what actions to take when they receive them – this may include reviewing and updating relevant distribution lists for information

If you work in a setting that provides care in clients’ own homes, you should:

• train staff to help them identify those most likely to be at risk from adverse cold weather; this training should address how to document risks and raise concerns where necessary, including providing contact details for local authority health and housing services
• provide staff with details of cost of living support, including help to manage energy bills that they can signpost clients to where appropriate

Responding to cold weather

If a CHA is issued, there are additional actions you should take.

Protect those at risk

In all settings, you should:

• consult the action card for providers to identify actions appropriate to the received alert level and distribute this information where necessary to your teams
• ensure that ice and/or snow is gritted or removed from priority areas and routes, if these occur

If you work in a care home or other residential setting, you should:

• prioritise maintenance of heating systems to keep rooms being used warm
• ensure that clients have access to other ways of keeping warm (for example blankets) if needed

If you work in a setting that provides care in clients’ own homes, you should:

• continue to ensure local actions for the vulnerable such as arranging daily contacts or visits are taking place, as outlined in the action card for providers
• ensure staff are undertaking appropriate home checks when visiting clients, for example, room temperature, medication and food supplies
• ensure that high-risk individuals are actively monitored during cold weather episodes, and that those most vulnerable to cold-related illnesses have visitor or phone call arrangements in place

Protect staff

During adverse cold weather, day-to-day practice may be disrupted. Staff may find it difficult to commute to work, or to reach clients through street outreach work. Staff absences may also be more likely due to, for example, respiratory illness. Business continuity plans may therefore need to be implemented.

Consider:

• identifying any staff who are more vulnerable to cold, and directing them to advice in, for example, UKHSA’s keeping warm and well: staying safe in cold weather guidance
• advice from the Health Safety Executive guidance on temperature in the workplace

Further resources and information

Additional documents

• Cold-Health Alert action card for providers
• Supporting vulnerable people before and during cold weather: guidance for healthcare professionals
• Keeping warm and well: staying safe in cold weather
• NICE quick guide for home care managers: helping to prevent winter deaths and illnesses associated with cold homes
• Adverse Weather and Health Plan
• Adverse Weather and Health Plan: supporting evidence
• Weather-Health Alerting System: user guide
• NHS England advice on how to stay well in winter

About the Cold-Health Alert System

Cold-Health Alerts will be issued to those who have signed up to the CHA system when the weather conditions have the potential to impact the health and wellbeing of the population. The alerts will be given a colour (yellow, amber or red) based on the combination of the impact the weather conditions could have, and the likelihood of those impacts being realised. These assessments are made in conjunction with the Met Office when adverse weather conditions are indicated within the forecast.

Yellow and amber alert assessments cover a range of potential impacts (for example impacts on specific vulnerable groups such as rough sleepers) through to wider impacts on the general population. They also cover the likelihood (low to high) of those impacts occurring. This combination of information on impacts and likelihood should help those making decisions about the appropriate level of response during an alert period. Within the alert that is issued, the combination of impact and likelihood will be displayed within a risk matrix. Red alerts indicate a national emergency with a risk to life for the general population, with wide ranging temperature impacts outside the health sector.

Once the decision is made to issue an alert, these will be cascaded to those registered to receive the alerts and made available on the new dedicated web platform. Alerts will be issued with as much lead time to the event as possible to allow users time to make their local assessments and to initiate all appropriate actions to reduce harm to health. Users should review every alert when issued to ensure they fully understand the potential impacts and how likely they are to occur.